Effect of ERCP burden on outcomes of subsequent laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in patients with concomitant gallbladder and common bile duct stones. However, the impact of ERCP-related factors on the technical difficulty and outcomes of LC remains unclear. This study aimed to evaluate the association between prior ERCP exposure and subsequent LC outcomes and to investigate the role of ERCP-related procedural factors.

Patients who underwent LC were retrospectively divided into ERCP and non-ERCP groups. To minimize baseline differences, propensity score matching (PSM) (1:1) was performed based on age, sex and ASA score. Following matching, perioperative outcomes were compared between groups to evaluate the impact of prior ERCP. Subgroup analyses within the ERCP cohort were performed according to ERCP-related variables, including indication, ERCP-LC interval, number of ERCP procedures, stone extraction and biliary stenting.

A total of 426 patients were included in the study. Following PSM, the rate of laparoscopic subtotal cholecystectomy (LSC) was significantly higher in patients with prior ERCP compared with controls (p = 0.003), whereas conversion to open surgery was similar between groups (p = 0.996). Within the ERCP cohort, patients who underwent ≥ 3 ERCP procedures or received ≥ 2 biliary stents had significantly higher rates of LSC (p = 0.004 and p = 0.008, respectively). Multiple stone extraction was associated with longer operative time in subgroup analyses. In multivariable analysis, ≥ 3 preoperative ERCP procedures were associated with LSC (OR 15.98, 95% CI 2.70-94.39; p = 0.002). This finding was consistent in a secondary sensitivity model including fewer covariates, in which repeated ERCP procedures remained significantly associated with LSC.

Prior ERCP is associated with increased operative difficulty during subsequent laparoscopic cholecystectomy. Among ERCP-related factors, repeated ERCP procedures, particularly undergoing three or more preoperative ERCP interventions, were associated with a higher likelihood of laparoscopic subtotal cholecystectomy. These findings suggest that cumulative ERCP burden may be associated with increased difficulty of subsequent laparoscopic cholecystectomy.