A Comparative Study between ERCP Stone Removal vs. Open CBD Exploration in Management of Choledocholithiasis (original) (raw)
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Choledocholithiasis: A Review of Management and Outcomes in a Regional Setting
Cureus, 2023
Background Choledocholithiasis is a common surgical presentation with an incidence of 8% to 16% in symptomatic cholelithiasis. Treatment often requires a multi-stage approach via endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), which can prolong the length of stay (LoS) and expose patients to unnecessary risks. A single-stage procedure, such as LC with common bile duct exploration (CBDE), is a safe and effective option that may decrease LoS. This study compares patient outcomes and management in a regional center and aims to identify factors that predict the presence of confirmed choledocholithiasis. Methods A retrospective cross-sectional analysis was performed on all patients admitted to Toowoomba Hospital for management of diagnosed or suspected choledocholithiasis from January 2021 to March 2023. Patient demographics, ERCP findings, and operative data were collated. Results A total of 195 patients were identified, including 136 patients undergoing multi-stage management, 34 patients who had an ERCP alone, and 25 patients who underwent single-stage management. Single-stage procedures had an 80% success rate with an average LoS of 3.6 days. Multi-stage procedures had an average LoS of 8.1 days and an ERCP success rate of 93%. Complication rates between ERCP (11.7%) and LC with CBDE (9.7%) were comparable. Time to index ERCP and serum bilirubin level were found to be significantly lower in those with positive index ERCP findings compared to those without. Conclusion Single-stage procedures are a safe way to manage choledocholithiasis and are associated with a reduced LoS when compared to multi-stage management, with comparable efficacy and morbidity rates.
Options and Strategies for the Management of Choledocholithiasis
World Journal of Surgery, 1998
The introduction of laparoscopic techniques for the management of biliary stone disease has expanded the therapeutic choices for surgeons confronted with choledocholithiasis. As new strategies emerge, the treatment of cholelithiasis and choledocholithiasis remains controversial. This paper discusses the options available for the treatment of common bile duct stones. Diagnostic and therapeutic algorithms are proposed. The treatment of these patients must be individualized, taking into consideration the condition of the patient, associated diseases, secondary complications of the gallstones, and the surgical expertise and resources of the institution.
The role of endoscopy in the management of choledocholithiasis
Gastrointestinal Endoscopy, 2011
The role of endoscopy in the management of choledocholithiasis This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1). 1 The strength of individual recommendations is based on both the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as "we suggest," whereas stronger recommendations are typically stated as "we recommend." This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines. Gallstone disease affects more than 20 million American adults 2 at an annual cost of $6.2 billion. 3 The incidence of choledocholithiasis ranges from 5% to 10% in those patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis 4-7 to 18% to 33% of patients with acute biliary pancreatitis. 8-11 The diagnostic approach to patients with suspected choledocholithiasis is addressed in a separate ASGE practice guideline. 12 This guideline addresses the role of endoscopy in the management of patients with known choledocholithiasis. Although data regarding the natural history of choledocholithiasis are limited, available studies indicate that 21% to 34% of common bile duct (CBD) stones will spontaneously migrate, 13,14 and migrating stones pose a moderate risk of pancreatitis (25%-36%) 13,14 or cholangitis if they obstruct the distal duct. 15 The natural history of CBD stones incidentally discovered during routine intraoperative cholangiography (IOC) at elective cholecystectomy may be less morbid than symptomatic CBD stones discovered pre-cholecystectomy. 16 However, because biliary pancreatitis and cholangitis may be life-threatening conditions, removal of discovered CBD stones is generally recommended. 17,18
Surgical management of choledocholithiasis: a single institutional experience
International Surgery Journal, 2022
Background: Choledocholithiasis is the 2nd most common complication of gallbladder stone disease and its incidence increases with age. There are different modalities of treatment ranging from endoscopic techniques to open and minimally invasive surgery. However, the single best modality has remained a point of major speculation. This study was undertaken to evaluate various modalities of surgical treatments undertaken at our institute.Methods: A retrospective analysis of all the patients who underwent surgery for common bile duct stones during the study period was done. The parameters analyzed were epidemiological data, clinical parameters, surgical details and any complications.Results: A total of 50 patients were included in the study with a M:F ratio of 1:1. The most common presenting complaint was pain abdomen and the majority, were post ERCP failure cases. The common cause for failure was multiple or impacted stones. Majority of the patients underwent an open surgery and a drai...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
The timing of minimally invasive approach of choledocholithiasis, using endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), is challenging. The aim of the present retrospective study was to assess the feasibility and safety of endoscopic stone removal for choledocholithiasis followed by same-day LC. Between October 2005 and February 2007, 27 patients diagnosed with choledocholithiasis were treated with this approach. Of these patients, nine (33%) had either pancreatitis or cholangitis. The mean age of the patients was 56 years (range, 29-78). ERCP was performed in the endoscopic unit, whereas LC was performed in the theater Success rate and clinical outcome were analyzed. Ninety-three percent clinical success was achieved. Two patients required conversion to opened cholecystectomy because of uncertain anatomy. There was no 30-day postoperative mortality. Two patients (7%) had postoperative complications (post-ERCP pancreatitis and superficial...
Combined balllon sphyncteroplasty in treatment of choledocholithiasis 2
Combined balllon sphyncteroplasty in treatment of choledocholithiasis: rewiew of the problem and our experience Cholelithiasis is a common disease, occurring in 5%–22% people in the western countries, among 8%–20% combined with common bile duct stone (CBDS) [1] The incidence in China is about 8%–10% and is still increasing. The overall the number of cholelithiasis patients has reached more than 100 million. Each year, more than 700 thousand people in the United States receive cholecystectomy, with 10%–15% combined with CBDS [2] The overall incidence of gallstones in Japan was about 10%, of which 20% were found in the longterm follow-up of CBDS [1] In addition, 6% of the patients with gallbladder resection in Europe to detect asymptomatic CBDS, at the same time 67% patients with CBDS were found to have gallbladder stones [3] The recurrence of choledocholithiasis after bile duct stones clearance involves complicated factors and cannot be completely elaborated by a single factor. The risk factors for recurrence of choledocholithiasis include bacteria, abnormal biliary structure, inflammation, endoscopic and surgical treatment, and so on. The main options for management of choledocholithiasis are endoscopic retrograde cholangiopancreatography (ERCP), LCBDE/ OCBDE. There are other options for the treatment such as dissolving solutions, ESWL percutaneous radiological interventions, electrohydraulic lithotripsy (EHL) and laser lithotripsy. In this article, we review the advances of recurrent factors and management of choledocholithiasis. Risk factors for the recurrence of choledocholithiasis Risk factors for choledocholithiasis include congenital, biological, and behavioral factors. Bile stasis and infection are important factors for primary CBDS formation. Anatomical abnormality causing bile stasis is one of the major risk factors, association with bile infection [4] Genetic factors account for the ethnic difference in the risk of CBDS formation. Except biological factors such as age, gender, and lipid metabolism, behavioral factors such as nutrition, obesity, rapid weight gain and loss, and exercise are also important. In addition to these factors, cholecystectomy at young ages leading to CBD dilatation is another acquired risk factor for CBDS [5] Furthermore, chronic inflammatory conditions such as Oddi dysfunction, primary sclerosing cholangitis, acquired mmunodeficiency syndrome, and parasites can lead to bileduct stones formation. Certain drugs are secreted into bile and may precipitate with calcium to form stones [6] Bacterium Brown pigment stones are main form of choledocholithiasis, usually attributed to bacteria factors. Brown pigment stones form not only within the gallbladder but also within the intrahepatic and extrahepatic ducts. They are uniformly infected with enteric bacteria and are usually associated with cholangitis. Bacteriological and morphological studies of 38 brown pigment CBDS were performed, with 80.5% bacteria positive of those stones culture. Enterococci were the most common organisms that were isolated. At the same time, scanning electron microscopy showed the presence of bacteria in 84.2% of the stones. Results of the bacteriological and morphological studies confirmed the close relationship between the presence of bacteria and the development of brown pigment stones [7] The pathogenesis of bacteria in brown pigment stones is complex, involving variant factors. Brown pigment stones are formed in