Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis

Fujing Lv, Shutian Zhang, Ming Ji, Yongjun Wang, Peng Li, Wei Han, Fujing Lv, Shutian Zhang, Ming Ji, Yongjun Wang, Peng Li, Wei Han

Abstract

Objective: The aim of this study was to investigate the value of a single stage with combined tri-endoscopic (duodenoscopy, laparoscopy and choledochoscopy) approach for patients with concomitant cholecystolithiasis and choledocholithiasis.

Methods: Fifty-three patients with combined gallbladder stones and common bile duct stones from February 2014 to April 2015 were randomized assigned to two groups: 29 patients underwent single-stage surgery with combined duodenoscope, laparoscope and choledochoscope (combined tri-endoscopic group), and 29 patients underwent endoscopic sphincterotomy to remove common bile duct stones followed by laparoscopic cholecystectomy several days later (control group). The success rate of complete stone removal, procedure-related complication, hospital stay and the cost of hospitalization were compared between the two groups.

Results: Altogether, 53 patients (29 patients in combined tri-endoscopic group and 24 patients in control group) successfully underwent the surgery and ERCP procedure. Three patients in the control group developed post-ERCP pancreatitis. One case of bile leaking and one case of residual stone were noted in the combined tri-endoscopic group. There were no significant differences between the two groups with regard to both complete stone removal [96.6 % (28/29) vs. 100 % (24/24)] and procedure-related complication rate [3.4 % (1/29) vs. 12.5 % (3/24)] (p > 0.05). No open surgery was required in either group. There were significant differences between the two groups with regard to hospital stay (6.72 ± 1.3 days vs. 10.91 ± 1.6 days, p < 0.01) and cost of hospitalization (15,724 ± 1613 CNY vs. 19,829 ± 2433 CNY, p < 0.05).

Conclusion: The single-stage combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis was just as safe and successful as the control group. In addition, it resulted in a shorter hospital stay and less cost.

Keywords: Cholecystolithiasis; Choledocholithiasis; Endoscopic retrograde cholangiopancreatography (ERCP); Laparoscope.

Conflict of interest statement

Compliance with ethical standards Disclosures Drs. LV Fujing, ZHANG Shutian, JI Ming, WANG Yongjun, LI Peng and HAN Wei have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Endoscopy view of various steps of performing single-stage procedure with combined tri-endoscopic approach for patients with concomitant gallbladder stones and CBD stones. A Choledochoscope is inserted directly into the dilated cystic duct under laparoscopic view. B Choledochoscopic view of common bile duct stone. C The guidewire is inserted into the CBD via choledochoscope and arrived at the lumen of the descending duodenum. D The hydrophilic end of the guidewire is caught and pulled out of the duodenoscope. E An ENBD tube is inserted along the guidewire. F The position of the ENBD tube is confirmed by choledochoscope

References

    1. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS) Gut. 2008;57:1004–1021. doi: 10.1136/gut.2007.121657.
    1. El-Geidie AA. endoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique? Surg Laparosc Endosc Percutan Tech. 2011;21:282–287. doi: 10.1097/SLE.0b013e3182218908.
    1. Duensing RA, Williams RA, Collins JC, Wilson SE. Managing choledocholithiasis in the laparoscopic era. Am J Surg. 1995;170:619–623. doi: 10.1016/S0002-9610(99)80028-2.
    1. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393. doi: 10.1016/S0016-5107(91)70740-2.
    1. Ranson JH. Etiologicaland prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol. 1982;77:633–638.
    1. Jagdish C, Anubhav J, Pawanindra L, Nikhil G, Kumar RV. Laparoscopic management of CBD stones: an Indian experience. Surg Endosc. 2011;25:172–181. doi: 10.1007/s00464-010-1152-5.
    1. Stokers ME. Common bile duct exploration in era of laparoscopic surgery. Arch Surg. 1995;130:265–269. doi: 10.1001/archsurg.1995.01430030035005.
    1. Costamagna G, Tringali A, Shah SK. Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence. Endoscopy. 2002;34:273–279. doi: 10.1055/s-2002-23632.
    1. Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol. 2002;97:2763–2767. doi: 10.1111/j.1572-0241.2002.07019.x.
    1. Kullman E, Borch K, Dahlin LG, Liedberg G. Long-term follow-up of patients with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis. Eur J Surg. 1991;157:131–135.
    1. Isaji S, Murabayashi K, Hayashi M, Nakano H, Uehara S, Kusuda T, Miyahara S, Maruyama A. Management of gallbladder and common bile duct stones: laparoscopic cholecystectomy combined with preoperative endoscopic sphincterotomy versus open surgery. J Hepato Biliary Pancreat Surg. 1996;3:452–456. doi: 10.1007/BF02349791.
    1. Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc. 2014;28:875–885. doi: 10.1007/s00464-013-3237-4.
    1. Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol. 2012;18:3156–3166. doi: 10.3748/wjg.v18.i24.3156.
    1. Liverani A, Muroni M, Santi F, Neri T, Anastasio G, Moretti M, Favi F, Solinas L. One-step laparoscopic and endoscopic treatment of gallbladder and common bile duct stones: our experience of the last 9 years in a retrospective study. Am Surg. 2013;79:1243–1247.
    1. Wright BE, Freeman ML, Cumming JK, Quickel RR, Mandal AK. Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure? Surgery. 2002;132:729–735. doi: 10.1067/msy.2002.127671.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera