Related Experiment Video
Updated: Jul 16, 2025
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event
Eric Bergeron1, Théo Doyon2, Thibaut Manière2
1Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada. eric.bergeron.med@ssss.gouv.qc.ca.
Insights
Recurrent biliary events (RBE) affect 28.5% of patients after common bile duct stone (CBDS) clearance. Performing cholecystectomy within 7 days of ERCP significantly reduces RBE and associated adverse outcomes.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Gallstone disease impacts 15% of adults, with up to 30% experiencing common bile duct stones (CBDS).
- Endoscopic retrograde cholangiopancreatography (ERCP) is standard for CBDS removal, followed by cholecystectomy to prevent recurrent biliary events (RBE).
- Without cholecystectomy, RBE incidence can reach 47%.
Purpose of the Study:
- To evaluate the timing of RBE occurrence after ERCP-mediated CBDS clearance.
- To assess the outcomes associated with RBE following gallstone disease management.
Main Methods:
- Retrospective review of 529 patients undergoing ERCP for gallstone disease and subsequent cholecystectomy (2010-2022).
- Identification and analysis of all RBE occurrences.
- Actuarial incidence calculation and comparative analysis between patients with and without RBE.
Main Results:
- 28.5% of patients experienced RBE, with a median time to first event of 34 days.
- Actuarial RBE incidence reached 2.5% at 7 days and 53.3% at 1 year.
- Patients with RBE had significantly longer hospitalizations, operative times, postoperative stays, higher rates of open surgery, and more complicated pathologies.
Conclusions:
- RBE occurred in 28.5% of patients, with a median onset of 34 days and early incidence of 2.5% within a week.
- Cholecystectomy is recommended within 7 days post-ERCP for CBDS clearance to prevent RBE.
- Timely cholecystectomy is crucial for mitigating RBE and improving patient outcomes.
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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