Comparison of the safety and efficacy of single-stage endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy versus two-stage ERCP followed by laparoscopic cholecystectomy six-to-eight weeks later: A randomized controlled trial

Abstract

INTRODUCTİON: Currently, the management of cholelithiasis in combination with choledocholithiasis involves endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy. However, recently, early surgical approaches are becoming more common, even in the treatment of acute cholecystitis. METODS: Patients diagnosed as having cholelithiasis and choledocholithiasis between October 2017 and May 2019 were prospectively enrolled in the study in a randomized manner. Patients undergoing ERCP + LC (laparoscopic cholecystectomy) in the same session were assigned to group A (n = 39), those undergoing ERCP + LC in the same hospitalization period were assigned to group B (n = 43), and patients who underwent delayed cholecystectomy after ERCP were included in group C (n = 37). RESULT: A total of 119 patients (47 females and 72 males) were included in the study and divided into three groups. Statistical comparisons of the study groups showed a significant difference between the three groups in terms of the length of hospital stay (days) and total cost (p < 0.001). The total cost was significantly higher for patients in group C in comparison with those in groups A and B (p < 0.001). Compared with patients in groups A and B, there was statistically significant difference in the length of hospital stay for patients in group C (p < 0.001). CONCLUSİONS: Single-stage ERCP plus LC is a safe and feasible strategy for the management of cholelithiasis and choledocholithiasis, offering advantages of cost, shorter hospital stay, and total anesthesia time. The major advantage of ERCP and LC performed in the same session and during the same hospitalization is the absence of the risk of recurrent episodes of acute cholecystitis, which occur with delayed cholecystectomy.

Keywords: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy.