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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2023

Open Access 19-09-2023 | Cholecystectomy | 2023 SAGES Oral

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Authors: Eric Bergeron, Théo Doyon, Thibaut Manière, Étienne Désilets

Published in: Surgical Endoscopy | Issue 12/2023

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Abstract

Background

Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes.

Methods

The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared.

Results

The study population is composed of 529 patients. Mean age was 58.0 (18–95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses.

Conclusions

RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Metadata
Title
Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event
Authors
Eric Bergeron
Théo Doyon
Thibaut Manière
Étienne Désilets
Publication date
19-09-2023
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10423-0

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