COMPARISON OF CLINICAL EFFICACY AND SAFETY OF LCBDE VERSUS ERCP IN THE TREATMENT OF BILE DUCT STONES AND ANALYSIS OF RELATED FACTORS INFLUENCING POST-OPERATIVE ACUTE PANCREATITIS
Main Article Content
Keywords
Acute pancreatitis, Bile duct stones, Cholangiopancreatography, Common Bile Duct, Intraoperative Complications, Tertiary Care, Treatment Comparison
Abstract
Background: Bile duct stones present a clinical challenge, and LCBDE (Endoscopic Retrograde Cholangiopancreatography) and ERCP (Laparoscopic Common Bile Duct Exploration) are two of the most prominent interventions.
Objectives: To compare the clinical efficacy and safety of these procedures, as well as to identify factors that influence post-operative acute pancreatitis.
Methods: This cross-sectional analysis was conducted at a tertiary care hospital in Lahore Pakistan between March 2022 and June 2023, enrolling 44 patients undergoing LCBDE and 92 patients undergoing ERCP. Inclusion criteria comprised patients aged 18-70 years with ultrasonographic evidence of cholecystolithiasis, among other parameters. A structured questionnaire was used to collect information extending from demographics to post-operative outcomes.
Results: The demographic characteristics of the two groups, including age, gender, and BMI, did not differ significantly. 70.45% of LCBDE patients had gallstones concurrently, compared to 53.26 % of ERCP patients (p>0.05). The number and magnitude of bile duct stones, as well as the duration of procedures, were comparable between groups. There were intraoperative complications in 13.6 of LCBDE patients and 19.0% of ERCP patients. Postoperatively, 11.4 of LCBDE patients and 14.4% of ERCP patients developed acute pancreatitis (p>0.05). Other complications and the need for secondary interventions were statistically comparable (p>0.05).
Conclusion: Both LCBDE and ERCP are efficacious and safe treatments for bile duct stones in a tertiary care setting. The outcomes of both procedures were comparable in terms of complications and clinical efficacy. Additional large-scale, randomized studies could support these findings.
References
2. McNicoll CF, Pastorino A, Farooq U, et al. Choledocholithiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441961/
3. Boyer JL. Bile formation and secretion. Compr Physiol. 2013 Jul;3(3):1035-78. doi: 10.1002/cphy.c120027.
4. Kim H, Shin SP, Hwang JW, Lee JW. Outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography versus primary LCBDE for managing cholecystocholedocholithiasis. J Int Med Res. 2020 Oct;48(10):300060520957560. doi: 10.1177/0300060520957560.
5. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013 Dec 12;2013(12):CD003327. doi: 10.1002/14651858.CD003327.pub4.
6. Lan WF, Li JH, Wang QB, Zhan XP, Yang WL, Wang LT, Tang KZ. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials. Eur Rev Med Pharmacol Sci. 2023 May;27(10):4656-4669. doi: 10.26355/eurrev_202305_32477.
7. Lei C, Lu T, Yang W, Yang M, Tian H, Song S, Gong S, Yang J, Jiang W, Yang K, Guo T. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc. 2021 Nov;35(11):5918-5935. doi: 10.1007/s00464-021-08648-y. Epub 2021 Jul 26.
8. Wang X, Dai C, Jiang Z, Zhao L, Wang M, Ma L, Tan X, Liu L, Wang X, Fan Z. Endoscopic retrograde cholangiopancreatography versus laparoscopic exploration for common bile duct stones in post-cholecystectomy patients: a retrospective study. Oncotarget. 2017 Jun 27;8(47):82114-82122. doi: 10.18632/oncotarget.18839.
9. Dedemadi G, Nikolopoulos M, Kalaitzopoulos I, Sgourakis G. Management of patients after recovering from acute severe biliary pancreatitis. World J Gastroenterol. 2016 Sep 14;22(34):7708-17. doi: 10.3748/wjg.v22.i34.7708.
10. Liu CL, Lo CM, Fan ST. Acute biliary pancreatitis: diagnosis and management. World J Surg. 1997 Feb;21(2):149-54. doi: 10.1007/s002689900207.
11. Pogorelić Z, Lovrić M, Jukić M, Perko Z. The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis. Children (Basel). 2022 Oct 19;9(10):1583. doi: 10.3390/children9101583.
12. Zhang WJ, Xu GF, Huang Q, Luo KL, Dong ZT, Li JM, Wu GZ, Guan WX. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg. 2015 Jan 26;15:7. doi: 10.1186/1471-2482-15-7.
13. Meseeha M, Attia M. Endoscopic Retrograde Cholangiopancreatography. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493160/
14. Almadi MA, Barkun JS, Barkun AN. Management of suspected stones in the common bile duct. CMAJ. 2012 May 15;184(8):884-92. doi: 10.1503/cmaj.110896.
15. Hu L, Shi X, Wang A. Comparison of different time intervals between laparoscopic cholecystectomy to endoscopic retrograde cholangiopancreatography for patients with cholecystolithiasis complicated by choledocholithiasis. Front Surg. 2023 Mar 15;9:1110242. doi: 10.3389/fsurg.2022.1110242.
16. Lee SJ, Choi IS, Moon JI, Choi YW, Ryu KH. Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old. J Minim Invasive Surg. 2022 Mar 15;25(1):11-17. doi: 10.7602/jmis.2022.25.1.11.
17. Li M, Tao Y, Shen S, et al. Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations. Surg Endosc. 2020;34:1551–1560.https://doi.org/10.1007/s00464-020-07429-3.
18. Li S, Guizzetti L, Ma C, et al. Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations. BMC Gastroenterol. 2023;23:254. https://doi.org/10.1186/s12876-023-02868-3
19. Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441940/
20. Liao Y, Cai Q, Zhang X, Li F. Single-stage intraoperative ERCP combined with laparoscopic cholecystectomy versus preoperative ERCP Followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: A meta-analysis of randomized trials. Medicine (Baltimore). 2022 Mar 11;101(10):e29002. doi: 10.1097/MD.0000000000029002.
21. Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Kakuma T, Tada S. Endoscopic retrograde cholangiopancreatography-related complications for bile duct stones in asymptomatic and symptomatic patients. JGH Open. 2021 Dec 2;5(12):1382-1390. doi: 10.1002/jgh3.12685.
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Rida Waheed Bhatti
House Officer, Sheikh Zayed Hospital, Lahore Pakistan
Muhammad Hamza Asif
House Officer, Sheikh Zayed Hospital, Lahore Pakistan
Mohammad A M A Mohammad
Royal College of Surgeons in Ireland
Tayyaba Ghulam
Post Graduate Trainee-General Surgery, Federal Government Services Hospital, Islamabad Pakistan
Reem Mohammad
Royal College of Surgeons in Ireland
Turki Aldhemeer
Royal College of Surgeons in Ireland