Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography

Abstract

There are no clinical guidelines for the timing of cholecystectomy (CCY) after performing therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. We tried to analyze the clinical practice patterns, medical expenses, and subsequent outcomes between the early CCY, delayed CCY, and no CCY groups of patients. 1827 choledocholithiasis patients who underwent therapeutic ERCP were selected from the nationwide population databases of two million random samples. These patients were further divided into early CCY, delayed CCY, and no CCY performed. In our analysis, 1440 (78.8%) of the 1827 patients did not undergo CCY within 60 days of therapeutic ERCP, and only 239 (13.1%) patients underwent CCY during their index admission. The proportion of laparoscopic CCY increased from 37.2% to 73.6% in the delayed CCY group. There were no significant differences (p = 0.934) between recurrent biliary event (RBE) rates with or without early CCY within 60 days of ERCP. RBE event-free survival rates were significantly different in the early CCY (85.04%), delayed CCY (89.54%), and no CCY (64.45%) groups within 360 days of ERCP. The method of delayed CCY can reduce subsequent RBEs and increase the proportion of laparoscopic CCY with similar medical expenses to early CCY in Taiwan’s general practice environment.

During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography?

“…The worst period, when looking at the same variables, is 4 to 30 days after ERCP. (9,10) ❚ CONCLUSION…”

“…Lower-risk patients can undergo laparoscopic cholecystectomy with cholangiography and laparoscopic exploration of the common bile duct, depending on the surgeon's skills and the equipment available at the hospital. (7)(8)(9)(10)(11)(12) Usually, if choledocholithiasis is identified but not removed during cholecystectomy, a subsequent ERCP is required for extraction of the stones. (13,14) Cholecystectomy must be performed safely, and inflammation resulting from the disease itself and manipulation during ERCP can hinder the surgery, increasing the operative time, the risk of bleeding and the conversion rate when compared with elective cholecystectomy without previous ERCP.…”

Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention

“…Although previous studies have shown differing results regarding cholecystectomy (CCY) due to cholelithiasis and subsequent ICC[ 32 ] or extra-hepatic cholangio-carcinoma[ 33 , 34 ], our prior study revealed that cholelithiasis patients who undergo endoscopic sphincterotomy/endoscopic papillary balloon dilatation (ES/EPBD) are at a greater risk for subsequent cholangiocarcinoma, while cholelithiasis patients who undergo CCY have reduced risk for subsequent cholangiocarcinoma[ 3 ]. These results can be explained by different inflammation sites or by CCY reducing recurrent biliary events (RBEs)[ 35 ] and further decreasing future cholangiocarcinoma rates.…”

Subsequent Cholecystectomy Is The Most Important Factor for Recurrent Biliary Event-Free Survival in High-Risk Acute Cholecystitis Patients after Gallbladder Drainage

“…Meanwhile, early CCY is a better choice than delayed CCY regarding hospital stay and medical expenses for treatment in some studies [14]. Still some references show that delayed CCY has a higher proportion of laparoscopy intervention [15] and a lower complication rate [16]. Although CCY is the only de nitive therapy for acute cholecystitis [4,9,17], there are patients with high short-term comorbidity risk for surgery.…”