Preoperative endoscopic treatment for the management of concomitant gallstones and common bile duct stones

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Mouna Medhioub
Amal Khsiba
Moufida Mahmoudi
Asma Ben Mohamed
Lamine Hamzaoui
Mohamed Moussadek Azouz

Abstract

Background : The combination of gallbladder stone and main biliary stone is seen in 10-25% of cases. Its management with the combination of endoscopic and surgical treatment is increasingly adopted.
Aim: To evaluate the efficacy and safety of preoperative retrograde endoscopic retrograde cholangiopancreatography in the treatment of concomitant gallstones and common bile duct stones.
 Methods: Retrospective study including patients with concomitant gallstones and common bile duct stones and who had preoperative endoscopic retrograde cholangiopancreatography. The rate of clearance from the main bile duct and the rate of complications were evaluated.
Results: One hundred and twenty patients aged 57.4±2.7 years were included on average. The rate of catheterization of the main bile duct was 90%. Endoscopic retrograde cholangiopancreatography was unnecessary in 34.1%. Main bile duct clearance was obtained in 95.5% of patients who presented lithiasis during the procedure. The endoscopic treatment was efficient in 53,3% of cases Post endoscopic retrograde post cholangio-pancreatography acute panreatitis occurred in 1.6% of cases with an overall complication rate of 6.6%.
Conclusion: Preoperative endoscopic treatment of concomitant gallstones and common bile
duct stones is effective with good safety.

Keywords:

Endoscopic retrograde cholangiopancreatography, sequential treatment, common bile duct stones, gallbladder stones.

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References

  1. Références : 1. McSherry CK, Ferstenberg H, Calhoun WF Lahman E, Virshup M.. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 1985; 202: 59- 63. 2. Shabanzadeh DM, Sorensen LT, Jorgensen T. A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology 2016; 150(1) : 156 -67. 3. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol.2016 ; 65(1):146-81. 4. Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M, Ah-Soune P et al . Endoscopic management of common bile duct stones:European Society of Gastrointestinal Endoscopy (ESGE) guideline .Endoscopy. 2019 ;51(5):472-91. 5. Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A.. Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 2006; 244: 889-93. 6.Rábago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I,et al. Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 2006; 38: 779-86. 7.Lella F, Bagnolo F, Rebuffat C, Scalambra M, Bonassi U, Colombo E.. Use of the laparoscopic-endoscopic approach, the so-called "rendezvous" technique, in cholecystocholedocholithiasis: a valid method in cases with patient-related risk factors for post-ERCP pancreatitis. Surg Endosc 2006;20: 419-23. 8. Tzovaras G1, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A,et al. Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial. Ann Surg 2012; 255: 435-39. 9. Sahoo MR, Kumar AT, Patnaik A. Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis. J Minim Access Surg 2014; 10: 139-43. 10. El Geidie AA, ElEbidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc 2011; 25: 1230-37. 11. Sarli L, Iusco DR, Roncoroni L. Preoperative endoscopic sphincterotomy and laparoscopic cholecystectomy for the management of cholecystocholedocholithiasis: 10-year experience. World J Surg .2003; 27: 180-6. 12. Hamy A, Hennekinne S, Pessaux P, Lada P, Randriamananjo S, Lermite E et al .Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis. Surg Endosc 2003 ;17: 872-75. 13. Rieger R, Wayand W . Yield of prospective, noninvasive evaluation of the common bile duct combined with selective ERCP/sphincterotomy in 1390 consecutive laparoscopic cholecystectomy patients. Gastrointest Endosc .1995 ;42: 6-12. 14. Sungler P, Boeckl O . EAES ductal stone study. Surg Endosc.1997 ; 11: 1057. 15. Widdison AL, Longstaff AJ, Armstrong CP .Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones. Br J Surg .1994 ; 81: 595-597. 16. Frossard JL, Hadengue A, Amouyal G, Choury A, Marty O, Giostra E et al Choledocholithiasis:a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc. 2000 ;51(2):175-9. 17. Tan C, Ocampo O, Ong R, Tan KS..Comparison of one stage laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of preoperatively diagnosed patients with common bile duct stones: a meta-analysis . Surg Endosc. 2018 ;32(2):770-8. 18. Gao YC, Chen J, Qin Q, Chen H, Wang W, Zhao J et al.Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones: A meta-analysis of randomized controlled trials. Medicine . 2017 ;96(37): e7925. 19. Arezzo A, Vettoretto N, Famiglietti F, Moja L, Morino M. Laparoendoscopic rendezvous reduces perioperative morbidity and risk of pancreatitis.Surg Endosc 2013; 27: 1055 -60.