Antegrade transcystic balloon dilatation in emergency laparoscopic cholecystectomy with MRCP validation

Endoscopic retrograde cholangiopancreatography (ERCP) remains the predominant treatment of common bile duct stones but single-stage laparoscopic management via antegrade transcystic balloon dilatation (ATBD) offers a compelling alternative. All prior studies validate success solely by intraoperative fluoroscopic cholangiography, with no prospective trial employing postoperative magnetic resonance cholangiopancreatography (MRCP).

This single-centre prospective study enrolled 100 consecutive patients with confirmed CBD stones requiring emergency laparoscopic cholecystectomy (LC). ATBD was attempted in all patients. Primary outcome was MRCP-confirmed CBD stone clearance. Secondary outcomes included operative time and postoperative complications.

One hundred consecutive patients were enrolled (median age 69 years; 38% male; 56% ASA III-IV). ATBD was performed in 88 patients (88%). Postoperative MRCP was performed in 86 of 88 patients (98%), with residual stones identified in 24 (28%; 95% CI 19.5-38.2%), corresponding to an MRCP-confirmed CBD clearance rate of 72% (95% CI 61.8-80.5%). The median operative time was 90 min (IQR 75-111.5). Among the 88 patients who underwent ATBD, postoperative complications occurred in 12 (14%), most commonly pancreatitis (4.5%) and deep surgical site infection (4.5%); one patient died following severe post-procedural pancreatitis with multiorgan failure. The median hospital length of stay was 6 days (IQR 4-7.5).

Postoperative MRCP identified residual stones in 28% of patients who underwent MRCP, corresponding to an MRCP-confirmed clearance rate of 72%. These findings support the routine use of postoperative MRCP in post-procedural assessment for patients undergoing transcystic laparoscopic common bile duct exploration.

NCT07490730, https://clinicaltrials.gov (registration date 16.03.2026).