CHOLECYSTECTOMY WITH INTRAOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: DOES THE ORDER MATTER?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Tract Disease

Background:

• Cholecystocholedocholithiasis treatment typically involves cholecystectomy (CCT) combined with endoscopic retrograde cholangiopancreatography (ERCP).
• Intraoperative CCT with ERCP offers improved success rates, reduced hospital stays, and lower costs.
• The optimal sequence of CCT and ERCP remains unclear in existing literature.

Purpose of the Study:

• To determine if the sequence of intraoperative ERCP relative to CCT affects patient outcomes and complication rates.
• To compare the efficacy and safety of performing ERCP before versus after CCT in a single procedure.

Main Methods:

• Retrospective case-control study analyzing patients who underwent CCT with intraoperative ERCP.
• Study period: January 2021 to June 2022.
• Setting: Tertiary hospital in southern Brazil, focusing on cholecystocholedocholithiasis cases.

Main Results:

• Out of 37 patients, 16 (43.2%) had ERCP performed before CCT.
• Overall bile duct cannulation success was 91.9%, with 75.7% achieving bile duct clearance. Post-ERCP pancreatitis occurred in 10.8%.
• No significant difference in CCT technical difficulty. The 'CCT First' group showed higher bile duct cannulation success (p=0.020). Younger age, distal CBD stones, and shorter procedure duration correlated with successful clearance. Lymphopenia and cholecystitis were linked to clearance failure.

Conclusions:

• The sequence of CCT and ERCP during the same procedure does not significantly alter complication rates or bile duct clearance success.
• Lymphopenia and cholecystitis are identified as predictors of failed bile duct clearance.
• This finding supports procedural flexibility in managing cholecystocholedocholithiasis.