Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis

Syrén, Eva-Lena; Sandblom, Gabriel; Eriksson, Staffan; Eklund, Arne; Isaksson, Bengt; Enochsson, Lars

doi:10.1007/s00464-019-07272-1

Cited by 10 publications

(4 citation statements)

References 31 publications

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“…Since several years the most common management of CBDS detected by cholangiography during cholecystectomy in Sweden is intraoperative rendezvous ERCP [ 1 , 30 ]. In these cases, access to the bile duct is facilitated by an antegrade guidewire from the cystic duct to the duodenum, and the rate of unsuccessful perioperative complications, particularly PEP, is low.…”

Section: Discussionmentioning

confidence: 99%

Outcome of ERCP related to case-volume

et al. 2022

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Background and aims In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes. Methods Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor. Results In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates. When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time. Conclusions The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.

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Section: Discussionmentioning

confidence: 99%

Outcome of ERCP related to case-volume

et al. 2022

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“…Even if cholecystectomy combined with rendezvous ERCP is standard in many departments, the decision on which treatment is used for CBDS is usually based on local tradition and ERCP-competence. Before the introduction of intraoperative rendezvous ERCP, it was common that patients with CBDS were treated with a two-stage procedure, either preoperative ERCP followed by cholecystectomy or cholecystectomy followed by postoperative ERCP [ 34 ]. There are still units where cholecystectomy is performed on regular basis but where there is a lack of ERCP resources and a two-stage procedure thus remains the only choice [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular complications after common bile duct stone extractions

et al. 2020

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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.

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“…Rendezvous technique: This technique is a well-established method for the management of CBD stones that combines ERCP-ES stone clearance and LC in the same operation with the patient under general anesthesia[ 1 , 6 , 25 ]. It is feasible, safe and effective not only in elective but also in emergency cases, as shown in a recent study including 61 cases and 120 cases, respectively[ 26 ].…”

Section: Managementmentioning

confidence: 99%

“…These differences were statistically significant ( P < 0.005)[ 29 ]. Therefore, the postoperative rendezvous ERCP-ES has been limited but is still an acceptable alternative method when relevant equipment is unavailable[ 25 ].…”

Section: Managementmentioning

confidence: 99%

Current management of concomitant cholelithiasis and common bile duct stones

Pavlidis¹,

Pavlidis²

2023

World J Gastrointest Surg

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The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

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Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis

Cited by 10 publications

References 31 publications

Outcome of ERCP related to case-volume

Outcome of ERCP related to case-volume

Cardiovascular complications after common bile duct stone extractions

Current management of concomitant cholelithiasis and common bile duct stones

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