Cardiovascular complications after common bile duct stone extractions

Abstract

Background Common bile duct stone (CBDS) is a common condition the rate of which increases with age. Decision to treat in particular elderly and frail patients with CBDS is often complex and requires careful assessment of the risk for treatmentrelated cardiovascular complications. The aim of this study was to compare the rate of postoperative cardiovascular events in CBDS patients treated with the following: ERCP only; cholecystectomy only; cholecystectomy followed by delayed ERCP; cholecystectomy together with ERCP; or ERCP followed by delayed cholecystectomy. Methods The study was based on data from procedures for gallstone disease registered in the Swedish National Quality Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006-2014. ERCP and cholecystectomy procedures performed for confirmed or suspected CBDS were included. Postoperative events were registered by cross-matching GallRiks with the National Patient Register (NPR). A postoperative cardiovascular event was defined as an ICD-code in the discharge notes indicating myocardial infarct, pulmonary embolism or cerebrovascular disease within 30 days after surgery. In cases where a patient had undergone ERCP and cholecystectomy on separate occasions, the 30-day interval was timed from the first intervention. Results A total of 23,591 underwent ERCP or cholecystectomy for CBDS during the study period. A postoperative cardiovascular event was registered in 164 patients and death within 30 days in 225 patients. In univariable analysis, adverse cardiovascular event and death within 30 days were more frequent in patients who underwent primary ERCP (p < 0.05). In multivariable analysis, adjusting for history of cardiovascular disease or events, neither risk for cardiovascular complication nor death within 30 days remained statistically significant in the ERCP group. Conclusions Primary ERCP as well as cholecystectomy may be performed for CBDS with acceptable safety. More studies are required to provide reliable guidelines for the management of CBDS.

Adverse Events in Endoscopic Retrograde Cholangiopancreticography for Choledoccolithiasis: A Holistic Perspective

“…The other two patients had mortality secondary to sepsis after prolonged ICU hospitalization after perforation. In a nationally based study, it was reported that postoperative death occurred in 1.97% of 8,790 patients who underwent ERCP for choledocolithiasis [ 24 ]. These data suggest that our mortality data are at an acceptable rate.…”

Current management of concomitant cholelithiasis and common bile duct stones

“…ERCP-ES and subsequent LC, the most preferred method worldwide[ 4 , 17 , 50 ], is a safe management process even in patients with cardiovascular disease[ 51 ]. A randomized controlled study showed that routine nasobiliary tubes after endoscopic CBD stone clearance can facilitate subsequent LC by the ability of the intraoperative cholangiography and ensure the anatomical integrity of the CBD[ 52 ].…”

The Diagnostic Value of GGT‐Based Biochemical Indicators for Choledocholithiasis with Negative Imaging Results of Magnetic Resonance Cholangiopancreatography

“…Sometimes the presence of small calculi was missed in preoperative examination, so that the surgeon did not carry out effective exploration of the common bile duct during the operation, resulting in residual common bile duct calculi. Common bile duct exploration should also not be performed too aggressively, as common bile duct exploration can lead to some of the more serious complications [ 13 ]. Therefore, the assessment and management of choledocholithiasis should be precise and cautious [ 14 ].…”