Endoscopic retrograde cholangiopancreatography versus laparoscopic exploration for common bile duct stones in post-cholecystectomy patients: a retrospective study
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Xiaohong Wang1,2,*, Chenguang Dai3,*, Zhonghua Jiang1,4, Lili Zhao3, Min Wang3, Limei Ma3, Xueming Tan3, Li Liu3, Xiang Wang3 and Zhining Fan3
1Department of Digestive Endoscopy and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China
2Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, China
3Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China
4Department of Gastroenterology, The First People’s Hospital of Yancheng, Yancheng, Jiangsu 224006, China
*These authors have contributed equally to this work
Zhining Fan, email: [email protected]
Keywords: ERCP (endoscopic retrograde cholangiopancreatography), LCBDE (laparoscopic common bile duct exploration), common bile duct, post-cholecystectomy, retrospective study
Received: November 22, 2016 Accepted: March 22, 2017 Published: June 27, 2017
Background and Objective: Common bile duct (CBD) stones are common in patients even after cholecystectomy. Besides endoscopic retrograde cholangiography (ERCP), laparoscopic common bile duct exploration (LCBDE) is also applied. This study aims to compare clinical indications, therapeutic benefits and complications for these two managements.
Methods: From October 2012 to February 2015, 1072 consecutive patients were diagnosed as choledocholithiasis in our single hospital. Post-cholecystectomy patients who underwent ERCP or LCBDE were included. Clinical data were analyzed, such as success rate, complications, procedure duration, postoperative hospital stay, total cost and recurrence of ductal stones. Prior ERCP, previous biliary anatomic alteration surgeries and lost to follow up were the excluding criteria.
Results: 141 patients were included according to the criteria, and 87 cases underwent ERCP and 54 cases underwent LCBDE. Age and sex distribution of patients were comparable between the two groups. The success rate for CBD stones clearance was 97.7% in the ERCP group, compared with 87.0% in the LCBDE group (p=0.03). The mean procedure duration was also significantly shorter in ERCP group (52.0±15.8 vs. 102.9±40.1 min; p<0.001). Postoperative hospital stay was similar (5.5±2.6 vs. 5.9±2.3 days; p=0.40). And no significant difference for postoperative complications (3.4% vs. 11.1%; p=0.15), total cost ($3787.1±1061.5 vs. $3983.54±1257.1, p=0.32), and the rate of bile duct stones recurrence (6.9% vs. 7.4%, p=1.00).
Conclusions: For clearing CBD stones in patients after cholecystectomy, ERCP was more efficient and might be the first choice, while LCBDE might be beneficial for patients with large stones.
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