Cardiovascular complications after common bile duct stone extractions
Related Experiment Video
Updated: Dec 16, 2025
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Eva-Lena Syrén1,2, Lars Enochsson3, Staffan Eriksson4,5
1Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden. eva.lena.syren@akademiska.se.
Insights
Treating common bile duct stones (CBDS) with ERCP or cholecystectomy shows acceptable safety. Further research is needed to establish definitive management guidelines for CBDS, especially in elderly patients.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Cardiovascular Medicine
Background:
- Common bile duct stone (CBDS) is a prevalent condition, particularly in aging populations.
- Treatment decisions for CBDS in elderly and frail patients necessitate careful evaluation of cardiovascular risks.
- Assessing treatment-related cardiovascular complications is crucial for managing CBDS.
Purpose of the Study:
- To compare the incidence of postoperative cardiovascular events in patients with CBDS undergoing different treatment strategies.
- To evaluate the safety of ERCP-only, cholecystectomy-only, and combined or sequential procedures for CBDS.
- To inform treatment decisions for CBDS, especially in high-risk patient groups.
Main Methods:
- Data from the Swedish National Quality Register for Cholecystectomy and ERCP (GallRiks) from 2006-2014 were analyzed.
- Included were ERCP and cholecystectomy procedures for confirmed or suspected CBDS.
- Postoperative cardiovascular events (myocardial infarct, pulmonary embolism, cerebrovascular disease) within 30 days were identified by cross-matching with the National Patient Register.
Main Results:
- A total of 23,591 patients underwent procedures for CBDS.
- Postoperative cardiovascular events occurred in 164 patients, and 225 patients died within 30 days.
- While univariable analysis suggested higher event rates with primary ERCP, multivariable analysis found no statistically significant difference in cardiovascular complications or 30-day mortality.
Conclusions:
- Both primary ERCP and cholecystectomy appear to be safe treatment options for CBDS.
- Additional research is required to develop robust guidelines for managing CBDS.
- The findings suggest that current treatment approaches for CBDS can be performed with acceptable safety profiles.
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 treatment-related 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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