Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan;40(1):475-479.
doi: 10.1007/s00464-025-12338-4. Epub 2025 Oct 24.

Sequential endoscopic and laparoscopic treatment for choledocholithiasis: a 30-year experience in the era of evolving techniques

Alessandro Delcarro  1 , Giovanni Cesana  2   3 , Francesca Ciccarese  2 , Matteo Uccelli  2 , Adelinda Angela Giulia Zanoni  2 , Riccardo Giorgi  2 , Alberto Oldani  2 , Carolina Rubicondo  2 , Marta Bonaldi  2 , Yongha Lee  2 , Davide Moioli  2 , Stefano Olmi  2   3
Affiliations

Sequential endoscopic and laparoscopic treatment for choledocholithiasis: a 30-year experience in the era of evolving techniques

Alessandro Delcarro et al. Surg Endosc. 2026 Jan.

Abstract

Background: Sequential endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC) is a standard minimally invasive approach for treating concomitant gallbladder and common bile duct stones. This study presents a 30-year experience with this strategy and compares its outcomes with emerging single-session techniques, including laparoscopic common bile duct exploration (LCBDE) and laparoendoscopic rendezvous (LERV).

Methods: Between October 1991 and December 2020, a total of 350 patients (mean age 65 years, range 35-80) underwent EST and/or ERCP followed by LC in a sequential treatment protocol for choledocholithiasis. Patient demographics, intra- and post-procedural variables, complication rates, and long-term outcomes were retrospectively reviewed. The success rate of stone clearance, morbidity, mortality, and recurrence rates were calculated.

Results: Of the 350 treated patients, 240 (68.6%) had confirmed CBD stones. ERCP/EST achieved stone clearance in a single-session in 180 patients (75%). Among the remaining cases, additional ERCP sessions were required, and 14 patients ultimately failed to achieve endoscopic clearance. Three patients discontinued treatment (two declined a second ERCP and one refused LC after endoscopic clearance). Laparoscopic cholecystectomy was aborted in three patients (one due to anesthetic intolerance and two due to severe inflammation). Post-procedural complications occurred in 21 patients (6%), predominantly comprising mild pancreatitis and minor bile leak, or wound infections. No mortality was observed. Median hospital stay was 5.5 days. Recurrent CBD stones were observed in 15 patients (4.3%), managed with repeat ERCP (8 cases) or surgical revision (7 cases).

Conclusions: While sequential therapy remains an effective and widely adopted technique, the growing body of evidence on single-session, minimally invasive strategies such as LCBDE and LERV offers valuable alternatives in selected scenarios. Each approach presents specific advantages and challenges, and the choice of treatment should be guided by individual patient characteristics, clinical context and available institutional expertise.

Keywords: Common bile duct stones; Endoscopic treatment; Laparoscopic cholecystectomy; Laparoscopy; Sequential therapy; Sphincterotomy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclosures: Drs. Alessandro Delcarro, Giovanni Cesana, Francesca Ciccarese, Matteo Uccelli, Adelinda Angela Giulia Zanoni, Riccardo Giorgi, Alberto Oldani, Carolina Rubicondo, Marta Bonaldi, Yongha Lee, Davide Moioli and Stefano Olmi have no conflicts of interest or financial ties to disclose.

References

    1. Neoptolemos JP, Carr-Locke DL, Fossard DP (1987) Preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones: a prospective randomized study. BMJ 294(6568):470–474. https://doi.org/10.1136/bmj.294.6568.470 - DOI - PubMed - PMC
    1. Bergeron É, Gagnon M, Garceau P, Bouchard A, Gagné J, Sideris L (2023) Risk of recurrent biliary events after endoscopic sphincterotomy and common bile duct stone clearance in patients awaiting cholecystectomy. Surg Endosc 37(11):8685–8695. https://doi.org/10.1007/s00464-023-09962-5 - DOI
    1. Qi M, Fan J, Du Z, Wang X, Huang C, Liu X et al (2023) Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis. Surg Endosc 37(6):3482–3493. https://doi.org/10.1007/s00464-022-09634-3 - DOI
    1. Qi S, Xu J, Yan C, He Y, Chen Y (2023) Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: a meta-analysis. Medicine (Baltimore) 102(36):e34884. https://doi.org/10.1097/MD.0000000000034884 - DOI - PubMed
    1. Cianci P, Restini E (2021) Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J Gastroenterol 27(28):4536–4554. https://doi.org/10.3748/wjg.v27.i28.4536 - DOI - PubMed - PMC

LinkOut - more resources