Clin Endosc.  2019 Jan;52(1):59-64. 10.5946/ce.2018.107.

Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization

Affiliations
  • 1Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
  • 2Shinozaki Medical Clinic, Tochigi, Japan. shinozaki-s@aqua.ocn.ne.jp
  • 3Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
  • 4Department of Surgery, Jichi Medical University, Tochigi, Japan.

Abstract

BACKGROUND/AIMS
The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the efficacy and safety of single-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis.
METHODS
We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis due to choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016.
RESULTS
Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients who underwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed during the same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomy during the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In the delayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences between the groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge.
CONCLUSIONS
Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due to choledocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe and feasible.

Keyword

Cholangitis; Choledocholithiasis; Cholangiopancreatography; Patient outcome assessment; Cholecystectomy, laparoscopic

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Cholecystectomy*
Cholecystectomy, Laparoscopic
Cholecystolithiasis
Choledocholithiasis
Hospitalization*
Humans
Medical Records
Operative Time
Patient Outcome Assessment
Postoperative Complications
Retrospective Studies

Figure

  • Fig. 1. Study flowchart. ERCP, endoscopic retrograde cholangiopancreatography.


Reference

1. Miura F, Takada T, Strasberg SM, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20:47–54.
2. Gigot JF, Leese T, Dereme T, Coutinho J, Castaing D, Bismuth H. Acute cholangitis. Multivariate analysis of risk factors. Ann Surg. 1989; 209:435–438.
3. Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20:24–34.
4. Eto K, Kawakami H, Haba S, et al. Single-stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non-randomized, open-label and exploratory clinical trial. J Hepatobiliary Pancreat Sci. 2015; 22:825–830.
Article
5. Khashab MA, Tariq A, Tariq U, et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol. 2012; 10:1157–1161.
Article
6. Navaneethan U, Gutierrez NG, Jegadeesan R, et al. Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis. Gastrointest Endosc. 2013; 78:81–90.
Article
7. Saito H, Kadono Y, Kamikawa K, et al. The incidence of complications in single-stage endoscopic stone removal for patients with common bile duct stones: a propensity score analysis. Intern Med. 2018; 57:469–477.
Article
8. Ramchandani M, Pal P, Reddy DN. Endoscopic management of acute cholangitis as a result of common bile duct stones. Dig Endosc. 2017; 29 Suppl 2:78–87.
Article
9. Hui CK, Lai KC, Yuen MF, et al. Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis? Gastrointest Endosc. 2003; 58:500–504.
Article
10. Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev. 2006; (4):CD004890.
Article
11. Mallick R, Rank K, Ronstrom C, et al. Single-session laparoscopic cholecystectomy and ERCP: a valid option for the management of choledocholithiasis. Gastrointest Endosc. 2016; 84:639–645.
Article
12. Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session: feasibility and safety. World J Gastroenterol. 2013; 19:6093–6097.
Article
13. Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut. 2017; 66:765–782.
Article
14. Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014; 20:13382–13401.
Article
15. Obara K, Haruma K, Irisawa A, et al. Guidelines for sedation in gastroenterological endoscopy. Dig Endosc. 2015; 27:435–449.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr