Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

Attaallah, Wafi; Cingi, Asım; Karpuz, Şakir; Karakuş, Mehmet Fatih; Günal, Ömer

doi:10.1007/s00464-015-4355-y

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…Moreover, conclusions about prophylactic stenting also remain limited since the reason to leave a stent is difficult to obtain from a retrospective point of view (choice of endoscopist, edema, bleeding, prophylactic). While stenting may be an effective step for definitive clearance of CBDS [ 65 ], cholecystectomy soon after clearance remains necessary and should not wait for the removal of the stent [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Bergeron,

Doyon,

Manière

et al. 2023

Surg Endosc

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Background Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. Methods The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. Results The study population is composed of 529 patients. Mean age was 58.0 (18–95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. Conclusions RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Bergeron,

Doyon,

Manière

et al. 2023

Surg Endosc

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“…Furthermore, the small-sized stones are found in the feces, in association with an apparently functioning gallbladder containing similar stones, indicating that the gallbladder is a major source of the migrating stones [2]. The major function of biliary stents is likely to trap stones within the CBD and to prevent stone impaction in the ampulla of Vater, since endoscopic biliary stenting is often used for large or difficult CBD stones after ERCP and ES [7], which provides an opportunity to subsequently remove CBD stones with minimal invasion [1]. Moreover, CBD stent placement maintains continuous bile drainage, which could reduce the risk of developing biliary sludge and bile stasis while alleviating gallbladder swelling and inflammation.…”

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confidence: 99%

Overcoming Ductal Block: Emergency ERCP and Sphincterotomy Plus Common Bile Duct Stenting Improves Therapeutic Outcomes in Severe Gallstone Pancreatitis

et al. 2021

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Predictive factors for extraction of common bile duct stones during endoscopic retrograde cholangiopancreatography in Billroth II anatomy patients

Zou

Jin

et al. 2019

Surg Endosc

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Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

Abstract: Biliary stenting may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP.

Cited by 6 publications

References 23 publications

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Overcoming Ductal Block: Emergency ERCP and Sphincterotomy Plus Common Bile Duct Stenting Improves Therapeutic Outcomes in Severe Gallstone Pancreatitis

Predictive factors for extraction of common bile duct stones during endoscopic retrograde cholangiopancreatography in Billroth II anatomy patients

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