[Endoscopic Retrograde Cholangiopancreatography before Gallbladder Removal - an Unholy Alliance?]

Endoscopic retrograde cholangiopancreaticography (ERCP) is, among other indications, performed in conjunction with cholecystectomy (CHE) for suspected bile duct stones. Due to its invasiveness, ERCP is an endoscopic examination with considerable morbidity and mortality and influence the perioperative outcome after CHE.In this retrospective and monocentric study, all patients who underwent CHE in Baden-Baden from 01.07.2018 to 31.12.2022 were consecutively examined. In this exploratory study, p values < 0.05 were assessed as statistically significant.942 patients with gallbladder surgery (CHE) were included. Of these, 158 patients (17%) had at least one preoperative ERCP (pre-ERCP). During this pre-ERCP, 89 patients (56.3%) had one or more stones removed or pus drained. Patients with pre-ERCP differed significantly from patients without pre-ERCP in terms of surgical procedure (laparoscopic, conversion, open), duration of surgery, hospital stay, need for conversion, surgical revision, morbidity, and mortality. However, a systematic bias was found, i.e. patients with pre-ERCP were significantly older, more often male and sicker (ASA classification). The multiple regression models showed that pre-ERCP was a significant factor for conversion or open cholecystectomy and for the occurrence of postoperative complications after CHE.In patients with cholecystectomy, pre-ERCP is associated with significantly more conversions, prolonged operating time and increased postoperative complication rates. Patients could therefore benefit from the "surgery first" mindset, i.e. primary cholecystectomy.