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Endoscopic cholangiography and stone removal prior to cholecystectomy. A more cost-effective approach than operative
G Van Stiegmann1, N W Pearlman, J S Goff
1Department of Surgery (Gastrointestinal/Tumor), University of Colorado, Denver.
Insights
Performing endoscopic retrograde cholangiography and stone removal before gallbladder surgery is more cost-effective. This approach can eliminate the need for operative common bile duct exploration, saving significant costs per patient.
Area of Science:
- Gastroenterology
- Surgical Economics
Background:
- Choledocholithiasis (bile duct stones) is a common complication of gallstones.
- Management often involves cholecystectomy with or without operative common bile duct exploration.
- Preoperative endoscopic intervention is an alternative management strategy.
Purpose of the Study:
- To evaluate the cost-effectiveness of preoperative endoscopic retrograde cholangiography (ERC) and stone removal compared to operative common bile duct exploration (CBDE) during cholecystectomy for suspected choledocholithiasis.
Main Methods:
- Retrospective review of 173 patients undergoing cholecystectomy, with 30 (17%) having CBDE.
- Analysis of 31 patients who underwent preoperative ERC and stone removal.
- Cost estimation based on local charges for procedures.
Main Results:
- Cholecystectomy with CBDE was $6730 more expensive per patient than cholecystectomy alone.
- ERC and endoscopic stone removal achieved 87% success in removing bile duct stones.
- Preoperative ERC could have theoretically eliminated 21 of 30 CBDEs, saving $85,526 ($2851 per patient).
Conclusions:
- Preoperative ERC and endoscopic stone removal is a more cost-effective strategy for patients with suspected choledocholithiasis undergoing cholecystectomy.
- This approach reduces the need for invasive operative common bile duct exploration.
- Optimizing patient management through endoscopic intervention improves economic outcomes in biliary surgery.
Abstract:
Would economic benefit result from performing endoscopic cholangiography and removal of common bile duct stones prior to cholecystectomy in patients who are suspected preoperatively of having choledocholithiasis? In this study, 173 patients had cholecystectomy and 30 (17%) had common bile duct exploration. Records of these patients were reviewed as were those of 31 patients who had only endoscopic cholangiography and endoscopic stone removal. Cost estimates were based on local charges. Cholecystectomy with common bile duct exploration was $6730 more per patient than cholecystectomy alone. Endoscopic cholangiography and endoscopic stone removal was 87% successful in removing duct stones. Had endoscopic cholangiography and endoscopic stone removal been performed preoperatively in patients undergoing cholecystectomy who had suspected choledocholithiasis, 21 of 30 common bile duct explorations could theoretically have been eliminated. This would have saved $85,526 or $2851 per patient undergoing common bile duct exploration. Our analysis suggests that patients who require cholecystectomy and have suspected choledocholithiasis may be treated more cost-effectively by performing endoscopic cholangiography and endoscopic stone removal immediately prior to cholecystectomy than by cholecystectomy and operative common bile duct exploration.