Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital

Rábago, Luís; Chico, Inmaculada; Collado, David; Olivares, Ana; Ortega, Alejandro; Quintanilla, E.; Delgado, María del Pilar Gutiérrez; Castro, José Luis; Llorente, Ricardo; Echarri, J Vázquez

doi:10.1007/s00464-011-1990-9

Cited by 13 publications

(15 citation statements)

References 46 publications

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“…Many experiences were reported in the literature [60][61][62][63] , confirming safety, excellent CBD clearance percentages, and short learning curves. The adjunct of the intraoperative procedure does not prolong hospitalization of routine LC [64] .…”

Section: Intraoperative Ercp (With Concomitant Laparoscopic Cholecystmentioning

confidence: 70%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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Section: Intraoperative Ercp (With Concomitant Laparoscopic Cholecystmentioning

confidence: 70%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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“…Over the past 20 years, LC has become the gold standard for surgical treatment of symptomatic biliary lithiasis, and its development has favored the appearance of a group of new endoscopic/surgical therapeutic possibilities for patients with choledocholithiasis, namely total laparoscopic treatment of choledocholithiasis versus endoscopic treatment using intraoperative ERCP (both single-stage treatments), or preoperative ERCP and postoperative ERCP with LC (2-stage treatment) 6.…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies are available comparing single-stage treatments (LCBDE and intraoperative ERCP) and 2-stage treatment (preoperative ERCP)6. Since the introduction of laparoscopic cholecystectomy in our institution in 1993, the standard treatment for CBDS had been preoperative ERCP/ES, followed by LC and postoperative ERCP/ES.…”

Section: Discussionmentioning

confidence: 99%

“…Application of these criteria reveals a high rate of false-positive diagnoses and many unnecessary ERCPs (40 % – 50 %) 17. Currently MRCP and endoscopic ultrasound are used routinely before ERCP to prevent unnecessary procedures but they are not available in our institution 5 6 7 8 9 10 11 18. …”

Section: Discussionmentioning

confidence: 99%

“…Management of symptomatic or incidentally discovered choledocholithiasis is still controversial. There is no clear consensus on the best therapeutic approach (endoscopic versus surgical) 3 4 5 6 7.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial

González¹,

Peña²,

Torres³

et al. 2016

Endosc Int Open

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Background and study aims: Overall, 5 % to 15 % of patients undergoing cholecystectomy for cholelithiasis have concomitant bile duct stones, and the incidence of choledocholithiasis increases with age. There is no clear consensus on the best therapeutic approach (endoscopic versus surgical). Patients and methods: A prospective randomized controlled clinical trial was performed to compare three treatment options for patients with choledocholithiasis at the National Center for Minimally Invasive Surgery in Havana, Cuba from November 2007 to November 2011. The patients were randomized in three groups. Group I: patients who underwent intraoperative cholangiography (IOC) to confirm the choledocholithiasis followed by laparoscopic cholecystectomy (LC) associated with intraoperative endoscopic retrograde cholangiopancreatography (ERCP), group II: patients who underwent preoperative ERCP followed by LC during the same hospital admission and group III: patients who underwent IOC to confirm the choledocholithiasis followed by LC associated with laparoscopic common bile duct exploration (LCBDE). Results: A total of 300 patients with suspected choledocholithiasis were included in the trial and were randomized. As a result, a total of 134 patients were diagnosed with the presence of choledocholithiasis and treated during the study period. There were no significant differences in success rates of ductal stone clearance, but retained stone, postoperative complications and length of hospital stay were better in group I. Conclusions: Intraoperative ERCP/ES shows a higher rate of common bile duct stones clearance, a shorter hospital stay, and lower morbidity, but further research with a larger study population is necessary to determine the additional benefits of this procedure. The results to date suggests that in appropriate patients, single-stage treatments are the best options.

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