ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure
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Current treatment of complicated calculous biliary disease typically involves a two-step procedure consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Alternatively, laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and intraoperative common bile duct exploration or ERCP at a later date may be performed. This study compared the benefits of the traditional two-step procedure to the novel one-step procedure for the management of calculous biliary disease.
A retrospective review of 20 patients was conducted comparing one-step to two-step procedures for the management of choledocholithiasis. We define the one-step procedure to be a laparoscopic cholecystectomy with IOC to confirm the presence or absence of stones. Intraoperative ERCP with stone extraction was conducted if necessary as part of the one-step procedure.
A statistically significant difference existed between hospital charges for one-step ($58,145.30, SD $17,963.09) and two-step ($78,895.53, SD $21,954.78) procedures (p = 0.033). Other parameters (length of stay, preoperative days) trended toward significance; however, statistical significance was not achieved.
There appears to be a significant cost reduction with implementation of the one-step treatment of calculous biliary disease. Further research with a larger study population is necessary to determine the additional benefits of this procedure and to help augment the surgical endoscopists’ armamentarium.
KeywordsCholecystectomy Choledocholithiasis Endoscopic retrograde cholangiopancreatography (ERCP) GI endoscopy One-step Two-step
We thank the University of Nevada School of Medicine Department of Surgery, the University Medical Center of Southern Nevada Department of Endoscopy, and the University of Nevada, Reno, Bioinformatics Center. Statistical support provided via National Institute of General Medical Sciences (8 P20 GM103440-11).
Drs. Jones, Johnson, Samourjian, Slauch, and Ozobia have no conflicts of interest or financial ties to disclose.
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