Same Anesthesia Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy

Abstract

Background: Successful combined Laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) in the Same Session (LESS) has been reported in several studies in adult patients with choledocholithiasis. Methods: This was a retrospective analysis of data collected prospectively in the Pediatric ERCP Database Initiative using REDCAP. Adverse events were recorded separately and were reviewed for this study. The primary outcome was the hospitalization days. Secondary outcomes included total duration of anesthesia, morbidity, time from diagnosis to procedure. Results: Twenty-five patients underwent LESS, and 42 underwent the traditional ERCP followed by laparoscopic cholecystectomy. The groups were similar in age, weight, ASA. The median length of stay in the LESS group was 3 days, compared with 4 days (P = .32). Total procedure time was similar between the 2 groups, but anesthesia time was shorter in the LESS group (P = .0401). Morbidity was similarly low between the 2 groups. Conclusions: Relative to 2 interventions, a single session combining ERCP and laparoscopic cholecystectomy in pediatric patients is effective with a similar adverse event rate and length of stay. The use of a single sedation and reduced total anesthesia time are potential benefits of this approach. This modality may be considered for pediatric patients with choledocholithiasis with or without hemolytic disease.

Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative

“…The overall adverse event rate was 9% in the cases of available data (106/1124), consistent with prior studies evaluating pediatric ERCP negative event rates ranging from 6.4% to 19% (1,6–13). This is a broader range than published literature about ERCPs performed on adults, where adverse event rates are approximately 5%–7% (3,18).…”

“…Other studies define trainee involvement as allowing 6 minutes of supervised endoscopy time to achieve biliary duct cannulation (4). While pediatric ERCP is thought to be more technically challenging, published pediatric studies suggest a similar trend of safety and rates of procedural success (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In a study of matched pediatric patients and adult controls, using the American Society for Gastrointestinal Endoscopy (ASGE) lexicon for adverse events, similar technical success rates, clinical success rates, complication rates, and fluoroscopy times were noted (18,19).…”

“…Only individuals with complete data entries for ERCP for the index admission were included in this study. Additional information regarding variable definitions and data collected in the PEDI database, as well as number of cases performed per site can be found in our prior publications (9,13,16,17).…”

Benefits of Early Post-Ercp Laparoscopic Cholecystectomy: A Single Centre Prospective Study

“…As confidence in this technique has strengthened, some researchers advocate performing the two procedures simultaneously on the same day, under a same anesthesia [13] . This further reduces the length of hospital stay and reduces treatment cost imparted to the patient.…”

Trends in Pediatric Endoscopic Retrograde Cholangiopancreatography and Interventional Endoscopy

“…4,7,8 In 2014, Troendle et al initiated the pediatric ERCP database initiative, a multicenter prospective database to evaluate indications, safety, and outcomes of ERCP in pediatric patients. 3,9 The pediatric ERCP database initiative has served as the basis for investigations into pediatric ERCP safety and efficacy, however, this database captures data from a limited number of large, tertiary care institutions and, thus, may not be completely representative of universal practice patterns and procedure-related outcomes. A more comprehensive assessment of the utilization of pediatric ERCP at a national level occurred in 2014, with trends from 2000 to 2009 showing increased utilization of therapeutic interventions.…”