World J Gastrointest Endosc. 2014 February 16; 6(2): 32-40.
Published online 2014 February 16. doi: 10.4253/wjge.v6.i2.32.
©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
Modern approach to cholecysto-choledocholithiasis
Lapo Bencini, Cinzia Tommasi, Marco Farsi, Division of Surgical Oncology, Department of Oncology, Azienda Ospedaliero-Universitaria di Careggi, 50131 Florence, Italy
Roberto Manetti, Unit of Surgical Endoscopy, Department of Medicine and Emergencies, Azienda Ospedaliero-Universitaria di Careggi, 50131 Florence, Italy
Received November 16, 2013; Revised January 1, 2014; Accepted January 15, 2014;
Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.
Keywords: Laparoscopy, Endoscopy, Laparo-endoscopic, Endoscopic retrograde cholangiography, Bile duct stones, Cholecystolithiasis, Common bile duct stones, Laparoendoscopic rendezvous
Core tip: There is no consensus on the correct strategy for the care of simultaneous gallbladder and common bile duct stones. Many therapeutic options are available, including laparoscopic, endoscopic, percutaneous and open traditional techniques, either through a combination of these treatments or by conducting them in a stepwise sequence.
Common bile duct stones (CBDS) occur in 8%-20%[1,2
] of patients suffering from gallstones, although actual incidences of CBDS in this patient group could be higher. The association of these two conditions can lead to many severe complications, such as acute biliary pancreatitis, jaundice and cholangitis, transforming the choice of the best strategy for treating a benign issue into a potentially life-threatening problem. Although some authors have advocated for a “wait and see” policy for asymptomatic gallbladder stones[3
], almost none could propose the same approach if CBDS are detected as well[2,4
]. Nonetheless, a significant paper also reported a conservative (no action) behavior for silent CBDS found during routine intraoperative cholangiogram (IOC)[5
]. Moreover, in the case of patients with severe comorbidity unfit for surgery and symptoms of CBD obstruction (jaundice, cholangitis, recurrent acute pancreatitis), the sole execution of a formal endoscopic retrograde cholangiography (ERCP) is often obligatory, leaving the gallbladder in situ
]. However, a Cochrane review failed to confirm the imperative necessity of an immediate ERCP to relieve acute pancreatitis without sepsis[7
]. A very intriguing observational study from Sweden[8
] reported a so-called “paradigm shift” from open choledochotomy and cholecystectomy toward bile duct clearance using the endoscopic route and selective laparoscopic cholecystectomy in patients suffering from cholecysto-choledocholithiasis (CCL).
While the “gold standard” of treatment for gallstones has been laparoscopic cholecystectomy (LC) since the early 1990s[9,10
] and ERC is considered optimal for isolated CBDS[4
], no consensus exists to address CCL[11,12
]. The European Association for Endoscopic Surgery published the comprehensive guidelines of minimally invasive approaches in 2006, but no robust statements were published regarding the best treatment for CCL[13
Many therapeutic options are available, including laparoscopic, endoscopic, percutaneous and open traditional techniques, either as a combination in a concurrent manner or as a stepwise sequence.
The choice of the best strategy is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another[12,14-18
However, the current standard of treatment for CCL is influenced by many different professionals, including gastroenterologists, anesthesiologists, surgeons and endoscopists, leading to some conflict regarding organizing approaches for treatment.
We performed a PubMed, Embase and Cochrane bibliographic search for CCL, updated in October 2013, by manually searching for interesting cross-matched references. Reporting on more recent articles, randomized clinical trials (RCTs) and meta-analyses was considered a priority. Intrahepatic bile duct stones represent a less common disease with several peculiar pathological etiologies and will not be considered further in this review. Despite some differences in the epidemiologic features of gallstones and CCL, a special effort was made to include papers published from all over the world, including North America, Europe and Asia.
DIAGNOSIS OF COMMON BILE DUCT STONES
The first crucial issue for correctly managing CCL is to reach a good diagnosis in order to reduce unplanned procedures, unnecessary invasive exams and under treatment. Traditionally, the gold standard of diagnosis is achieved by cholangiography, which can be conducted by means of an intraoperative route (injecting the contrast medium through the cystic or the common bile duct), by an endoscopic papillary injection or even by a percutaneous approach. All methods are, of course, invasive.
Since the advent of laparoscopy, the preoperative diagnosis of CBDS has become increasingly popular due to the need for avoiding laparoscopic IOC and further treatments that were, at the beginning of the experience, highly demanding. Moreover, the widespread adoption of ERCP, even as a diagnostic tool, enormously impacted the development of some excessively invasive algorithms due to success rates of CBD clearance of almost 98% in the hands of experienced endoscopists[19
Currently, IOC is routinely performed in some centers[20-22
] and selectively in others[23,24
], while it is easily reproducible by the majority of surgeons. Nevertheless, the definitive acceptance of one policy over another has not been confirmed[25
], with selective IOC having some advantages in terms of a shorter operating time and fewer perioperative complications but at the price ofa higher readmission rate if CBDS are subsequently detected[22
]. Moreover, laparoscopic CBD exploration is becoming more popular, while intraoperative or postoperative ERCP is also safe and effective. However, current good practice should reserve the use of ERCP for those patients with CBDS as a therapeutic strategy only in selected doubtful cases[18
] due to the possibility of complications[26-28
] and false-positives.
Many of the diagnostic flow-charts and algorithms proposed consider a baseline stratification of the risk of having CBDS, including ultrasonography dilatation of the CBD and biochemical parameters, such as gamma-glutamyl transpeptidase, transaminases, alkaline phosphatase, bilirubin and lactatedehydrogenase. All of these markers are combined in predictive models[16,29
] to reserve more invasive or expensive imaging - cholangiography by ERCP or IOC, magnetic resonance cholangiography (MRC) and endoscopic ultrasonography (EUS) - for higher-risk patients, although no clinical-laboratory parameter is able to predict CBDS with optimal accuracy[30
Currently, the most importantpreoperative diagnostic tools are MRC and the traditional ultrasound[31-35
]. Alternatively, the policy of routine MRC was not found to be cost-effective in patients without symptoms or suspicion of CBDS, whereas IOC during LC was the best strategy[36
]. Interestingly, some authors reported[37
] the routine use of IOC during LC, even after MRC and successful preoperative ERCP, to detect residual CBDS. Indeed, due to the higher sensibility of IOC over MRC, it could be hypothesized that there is no need to conduct preoperative MRC in those patients suspected to have CBDS who are already scheduled for an intervention[38
Recently, introducing EUS added a new tool to the diagnostic algorithm of CDS. Despite the relatively scarce use of this technique among many hospitals worldwide, its routine use, at least in patients with intermediate and high risk of CBDS[39-42
], could play an important role for the next future two-stage strategy. A proposed rational sequence could reserve EUS for those patients with intermediate to high risk of CBDS and a negative MRC[43
]. A realistic and intriguing new proposal could consider the adoption of EUS in selected patients suspected to have CBDS, followed by a consecutive session of ERCP[44
The role of the CT scan in detecting CBDS is quite marginal, and its use is limited by the low frequency of radiopaque stones and cut-off size[45
]. However, it may be useful when a silent incidental stone is found.
There are many options to treat CCL, but each one has different advantages and limitations. Few trials have demonstrated robust evidence of one method’s superiority over another. The local availability of both technical resources and professional expertise could also play a pivotal role in deciding which treatment to administer.
From a historical point of view, CBD exploration has been performed at the same time as a cholecystectomy by open choledochotomy with papillotomy and stone extraction, often with a T-tube placement, with an unacceptable morbidity and mortality[11,46
]. Therefore, it was proposed to abandon this method on a routine basis 20 years ago[47
]. A more recent retrospective series reported good results with primary closure of choledochotomy where endoscopic and minimally invasive facilities are not available[48
]. Currently, open choledochotomy and papillotomy could still play a role in those cases with intraoperative unexpected diagnosis of choledocholithiasis and cholangitis, with bile duct dilatation or where all other endoscopic, percutaneous and laparoscopic approaches failed. Open choledochotomy and papillotomy could also be used in the case of a pre-existing open surgery that limits the application of endoscopic approaches (i.e
., Roux-en-Y intestinal reconstruction after gastrectomy)[11
Preoperative ERCP (and sub-sequential laparoscopic cholecystectomy)
A CBD clearance can be carried out by ERCP with endoscopic sphincterotomy (ES) before LC in many cases, and it is most likely the most common strategy used in the majority of hospitals worldwide[4
]. As previously reported, due to its intrinsic invasiveness, ERCP should be proposed for those patients with confirmed bile duct stones only. Furthermore, there is the possibility of some increased difficulty when performing LC after an endoscopic procedure[49
]. Thus, this two-stage strategy raises the problem of a close sequence of pre-endoscopic imaging through conventional US, MRC or EUS and a following LC within a maximum of 72 h that, practically, leads to some organizational problems in a busy hospital setting. The other drawback of any two-stage procedure is that the patient undergoes two different uncomfortable anesthesiologic sessions.
Postoperative ERCP (after laparoscopic cholecystectomy)
In those patients with a lower risk of CBDS, a policy of selective IOC and ERCP after LC seems to be rational[50
]. Similar situations are represented by intraoperative diagnosis of CBDS when an endoscopist or a surgeon trained to perform a laparoscopic bile duct clearance is not available in the operating theatre or in those cases of misdiagnosed CBDS discovered only after LC. Obviously, two anesthesiologic sessions are needed, which are likely to disturb the patient. Lastly, the main risk of such an approach is to fail a complete bile duct clearance postoperatively and to then have to conduct further procedures[51
Intraoperative ERCP (with concomitant laparoscopic cholecystectomy)
The single-stage laparoendoscopic treatment, known as the “Rendez-vous Technique” (RVT), is used to indicate simultaneous LC and intraoperative ERCP, facilitated by papilla visualization and cannulation through a guide-wire the surgeon inserts into the cystic duct. The technique was first described almost 20 years ago[52-54
], and hypothetically, it combines many advantages, such as minimal invasiveness and an acceptable learning curve, at the price of some organization troubles between endoscopists, surgeons and operating room personnel[55-57
], but is yet to be accepted. A robust review by La Greca et al[58
] analyzed data from 27 papers, which included almost 800 patients and compared the RVT to other approaches. This research showed an overall bile duct clearance of 92.3% and few complications (1.6%-6% bleeding from the sphincterotomy and 1.7%-7% pancreatitis). These advantages are related to the use of a guide wire that allows a facilitatedcannulation of the papilla without the risk of irritating the pancreatic duct.
The initial drawback of the endoscopic step completed in the supine position of the patient has not been confirmed[59
]. Many experiences were reported in the literature[60-63
], confirming safety, excellent CBD clearance percentages, and short learning curves. The adjunct of the intraoperative procedure does not prolong hospitalization of routine LC[64
Concomitant laparoscopic cholecystectomy and common bile duct exploration
One possible exciting and rational option to address CCL is conducting laparoscopic CBD exploration (LCBDE) during routine LC[65
]. In this case, the surgeon is able to resolve the patient’s disease completely during the same session, avoiding the risks of sphincterotomy[26
] and withoutthe need to conduct further treatments. Additionally, the abovementioned preoperative step of diagnosis could be outdated (an IOC is mandatory before LCBDE). Some surgeons with sufficient expertise in advanced laparoscopy have proposed LCBD as an excellent option for CCL[66,67
], but acceptance of such a technique in most hospitals is far off due to its steep learning curve, especially when a T-tube has to be used[68
Moreover, the surgeon’s experience influences the choice of technical procedure, such as the extraction of stones by the transcystic route[69
] rather than performing a choledochotomy or the decision to do primary closure versus T-tube placement[70
None of these differences, however, impacted the patients’ final outcomes. One of the most challenging maneuvers during LCBDE is the placement of a T-tube after closing the choledochotomy, but the real advantages, in terms of postoperative morbidity, of such a procedure are not confirmed according to a recent review article and meta-analysis[71
Shifts between the approaches and other techniques
The spectrum of variability of the different approaches is prone to some percentage of failure. Notwithstanding these limitations, almost each of these techniques can be used if one does not work, raising the overall success rates. For example, the RVT could be attempted in the case of uncompleted preoperative ERCP caused by a difficult papillary approach[72
]. Alternatively, if the guide-wire insertion through the cystic duct during the RVT is not possible, a skilled endoscopist is able to complete the one-stage procedure through a conventional intraoperative ERCP[57
]. Moreover, a failed preoperative or intraoperative ERCP could lead to an LCBDE or an open intervention, while a second-look at a multiple-session ERCP (often with stenting) is always possible with the help of shock-wave technologies or percutaneous trans-hepatic treatments[73-75
COMPARING THE DIFFERENT TECHNIQUES
In times of reduced resources, it is of utmost importance whether the one-stage management of patients with CCL is associated with reduced costs compared with a two-stage procedure[76
]. However, the economic pressure should be balanced with some learning curve to gain experience with more recent mini-invasive single-stage strategies, with the goal of similar patient outcomes. A summary of the pros and cons of each different strategy is shown in Table .
Comparison of the available approaches to concomitant lithiasis of gallbladder and common bile duct
One of the first logical consequences of introducing ERCP in almost all hospitals was limited mass open operations, while advanced laparoscopy led to comparing the open procedure and CBD clearance with the total laparoscopic approach. LCBDE was confirmed to be superior compared to open surgery in terms of mortality and morbidity (but less effective for common bile duct clearance) since 2006[77
]. Theoretically, LCBDE minimizes the risks of post-ERCP complications[26-29
] and the need for further anesthesia, with an excellent success rate of stone extraction (more than 90%)[67,77
]. However, LCBDE remains limited to centers with advanced laparoscopic expertise[12
Furthermore, the high availability of ERCP in almost all hospitals limited the mass of such study designs, and the acceptance of the superiority of LC over open operation avoided further protocols. Indeed, one recent prospective trial comparing LCBDE and open surgery confirmed the superiority of the laparoscopic method in terms of efficiency, morbidity and mortality[78
When comparing the two-stage (LC with preoperative or postoperative ERCP) and single-stage (LC with LCBDE), no significant differences were found, except for some intrinsic characteristics (fewer therapeutic sessions)[79,80
]. Another trial[81
] reported having a reduced hospital stay when using LCBDE.
A very recent review and meta-analysis[82
] of six RCTs comparing prospectively preoperative ERCP and RVT concluded that the latter method resulted in a reduced incidence of endoscopy-related pancreatitis and a shorter hospital stay, although stone clearance and overall morbidity were almost equivalent. Another meta-analysis[83
] included RVT in the so-called one-stage procedure, merging studies regarding LCBDE and comparing this group to the two-stage procedures (LC preceded or followed by ERCP). Again, no statistically detectable differences in patients’ outcomes were recorded between the two strategies.
], conducted only by comparing two-stage procedure clearance versus RVT, found a reduced incidence of postoperative pancreatitis with the latter method (2.4% instead of 8.4; OR, 0.33; 95%CI: 0.12-0.91, P
= 0.03). Another group[85
] published the results of a comparative study of 200 patients, suggesting the superiority of RVT over preoperative ERCP in terms of hospital stay. In contrast, the RCT published by Rábago et al[86
] reported similar percentages of CBD clearance between the two approaches. A study by Hong et al[87
] compared LCDE and RVT, and no differences were found between the two groups regarding duration of surgery, success rate, complications, retained stones, hospital stay, and costs. Another study[88
] also reported similar ductal stone clearance rates, although LCBDE was associated with shorter hospital costs.
The most updated and comprehensive review of available literature likely was published in 2013 by the Cochrane Group[89
]. After a careful and rigorous selection, only 16 RCTs, including a total of 1758 patients, were taken into consideration. The trials compared most of the options available to treat CCL. Although the authors advised about the high risk of bias, they found no significant difference in the mortality and morbidity between open surgery versus ERCP clearance (1% vs
3%, 20% vs
19%, respectively). However, patients who received open surgery had fewer retained stones (6% vs
Again, there was no significant difference in the main outcomes between LCBDE and pre-operative ERCP. Similar results were found when comparing trials on LCBDE vs RVT or post-operative ERCP. Interestingly, there was a detectable difference in the numbers of retained stones between LCBDE and postoperative ERCP (9% vs 25%). Therefore, single-staged LCBDE vs two-staged pre-operative or post-operative ERCP appeared to lead to comparable results in terms of mortality and morbidity, with a non-significant difference in the percentage of retained stones in the single-stage group (8% vs 14%, P = 0.94). The authors concluded that open bile duct surgery seems superior to ERCP in achieving CBDS clearance, but data referred to the early endoscopy era.
Presently, no single study comparing the whole spectrum of treatments (preoperative, postoperative ERCP, LCBDE, RVT) has been published, most likely due to the unrealistic contemporaneous presence of so many professionals and dedicated resources in the same facility. In our department, for example, there is a great availability of very skilled endoscopists (three professionals) who are able to manage intraoperative ERCP with challenging situations, while MRC needs a long time to be scheduled due to a very busy imaging service. However, it is very difficult to schedule several LC within an appropriate time after a preoperative ERCP, which is to be balanced with oncologic patients. Therefore, our approach to CCL is usually based on the RVT[57
From a theoretic point of view, the best approach should be that in which all options are available in the same facility, modulating each one according to the single patient. Moreover, in the case of failure, other options could be proposed to guarantee a successful CCL resolution. A proposed algorithm is shown in Figure .
A proposed algorithm for a combined-multimodal approach to cholecysto-choledocholithiasis. CCL: Cholecysto-choledocholithiasis; ERC: Erythropoietin-responsive cells; RVT: Rendez-vous Technique; LCC: Laparoscopic cholecystectomy.
The current management of CBD stones associated with gallstones requires an adequate approach due to the possibility of perioperative morbidity and mortality with severe impact on the quality of life. Many strategies are available at present, mostly involving LC as a pivotal step in the entire process. The extremities of the spectrum of treatments are represented by open traditional surgery and full laparoscopic cholecystectomy with CBD clearance. However, in the majority of hospitals worldwide, ERCP is the preferred choice used to complete an LC. Timing of the ERCP (preoperative, intraoperative or postoperative) is often dictated by the local presence of professional expertise and resources, rather than by a real superiority of one method over another. However, data refer to the early spectrum of treatments, which are influenced by economic pressure to prefer single-stage management approaches.
Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc.
Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol.
Schmidt M, Dumot JA, Søreide O, Søndenaa K. Diagnosis and management of gallbladder calculus disease. Scand J Gastroenterol.
Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut.
Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg.
Bignell M, Dearing M, Hindmarsh A, Rhodes M. ERCP and endoscopic sphincterotomy (ES): a safe and definitive management of gallstone pancreatitis with the gallbladder left in situ. J Gastrointest Surg.
Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev.
Sandzén B, Haapamäki MM, Nilsson E, Stenlund HC, Oman M. Treatment of common bile duct stones in Sweden 1989-2006: an observational nationwide study of a paradigm shift. World J Surg.
NIH Consensus conference. Gallstones and laparoscopic cholecystectomy. JAMA.
Sain AH. Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg.
Parra-Membrives P, Díaz-Gómez D, Vilegas-Portero R, Molina-Linde M, Gómez-Bujedo L, Lacalle-Remigio JR. Appropriate management of common bile duct stones: a RAND Corporation/UCLA Appropriateness Method statistical analysis. Surg Endosc.
Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg.
Treckman J, Sauerland S, Frilling A, Paul A. Common bile duct stones–Update 2006. In:Neugebauer E, Sauerland S, Fingerhut A, Millat G, Buess G.,editors.EAES Guidelines for Endoscopic Surgery–Twelve Years Evidence-based Surgery in Europe.
Berlin: Springer; 2006.pp.329-333. [DOI]
Lahmann BE, Adrales G, Schwartz RW. Choledocholithiasis--principles of diagnosis and management. Curr Surg.
Li MK, Tang CN, Lai EC. Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era: a systematic review. Asian J Endosc Surg.
Almadi MA, Barkun JS, Barkun AN. Management of suspected stones in the common bile duct. CMAJ.
De Palma GD. Minimally invasive treatment of cholecysto-choledocal lithiasis: The point of view of the surgical endoscopist. World J Gastrointest Surg.
Buxbaum J. Modern management of common bile duct stones. Gastrointest Endosc Clin N Am.
Tantau M, Mercea V, Crisan D, Tantau A, Mester G, Vesa S, Sparchez Z. ERCP on a cohort of 2,986 patients with cholelitiasis: a 10-year experience of a single center. J Gastrointestin Liver Dis.
Sanjay P, Kulli C, Polignano FM, Tait IS. Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland. Ann R Coll Surg Engl.
Buddingh KT, Weersma RK, Savenije RA, van Dam GM, Nieuwenhuijs VB. Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography. J Am Coll Surg.
Sajid MS, Leaver C, Haider Z, Worthington T, Karanjia N, Singh KK. Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl.
Horwood J, Akbar F, Davis K, Morgan R. Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Ann R Coll Surg Engl.
Tabone LE, Sarker S, Fisichella PM, Conlon M, Fernando E, Yi S, Luchette FA. To ‘gram or not’? Indications for intraoperative cholangiogram. Surgery.
Ford JA, Soop M, Du J, Loveday BP, Rodgers M. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg.
Arata S, Takada T, Hirata K, Yoshida M, Mayumi T, Hirota M, Yokoe M, Hirota M, Kiriyama S, Sekimoto M. Post-ERCP pancreatitis. J Hepatobiliary Pancreat Sci.
Vila JJ, Artifon EL, Otoch JP. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided?. World J Gastrointest Endosc.
Coelho-Prabhu N, Shah ND, Van Houten H, Kamath PS, Baron TH. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open.
Jovanović P, Salkić NN, Zerem E, Ljuca F. Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis. Eur J Intern Med.
Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc.
Prat F, Edery J, Meduri B, Chiche R, Ayoun C, Bodart M, Grange D, Loison F, Nedelec P, Sbai-Idrissi MS. Early EUS of the bile duct before endoscopic sphincterotomy for acute biliary pancreatitis. Gastrointest Endosc.
Liu CL, Lo CM, Chan JK, Poon RT, Lam CM, Fan ST, Wong J. Detection of choledocholithiasis by EUS in acute pancreatitis: a prospective evaluation in 100 consecutive patients. Gastrointest Endosc.
Makary MA, Duncan MD, Harmon JW, Freeswick PD, Bender JS, Bohlman M, Magnuson TH. The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann Surg.
Berthou JCh, Dron B, Charbonneau P, Moussalier K, Pellissier L. Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc.
Bahram M, Gaballa G. The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones. Int J Surg.
Epelboym I, Winner M, Allendorf JD. MRCP is not a cost-effective strategy in the management of silent common bile duct stones. J Gastrointest Surg.
Ueno K, Ajiki T, Sawa H, Matsumoto I, Fukumoto T, Ku Y. Role of intraoperative cholangiography in patients whose biliary tree was evaluated preoperatively by magnetic resonance cholangiopancreatography. World J Surg.
Richard F, Boustany M, Britt LD. Accuracy of magnetic resonance cholangiopancreatography for diagnosing stones in the common bile duct in patients with abnormal intraoperative cholangiograms. Am J Surg.
Vázquez-Sequeiros E, González-Panizo Tamargo F, Boixeda-Miquel D, Milicua JM. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography. Rev Esp Enferm Dig.
Lin LF, Huang PT. Linear endoscopic ultrasound for clinically suspected bile duct stones. J Chin Med Assoc.
Krawczyk M, Stokes CS, Lammert F. Genetics and treatment of bile duct stones: new approaches. Curr Opin Gastroenterol.
Chan HH, Wang EM, Sun MS, Hsu PI, Tsai WL, Tsai TJ, Wang KM, Chen WC, Wang HM, Liang HL. Linear echoendoscope-guided ERCP for the diagnosis of occult common bile duct stones. BMC Gastroenterol.
Chen CC. The efficacy of endoscopic ultrasound for the diagnosis of common bile duct stones as compared to CT, MRCP, and ERCP. J Chin Med Assoc.
Benjaminov F, Stein A, Lichtman G, Pomeranz I, Konikoff FM. Consecutive versus separate sessions of endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for symptomatic choledocholithiasis. Surg Endosc.
Kim CW, Chang JH, Lim YS, Kim TH, Lee IS, Han SW. Common bile duct stones on multidetector computed tomography: attenuation patterns and detectability. World J Gastroenterol.
Wills VL, Gibson K, Karihaloot C, Jorgensen JO. Complications of biliary T-tubes after choledochotomy. ANZ J Surg.
Pitt HA. Role of open choledochotomy in the treatment of choledocholithiasis. Am J Surg.
Ambreen M, Shaikh AR, Jamal A, Qureshi JN, Dalwani AG, Memon MM. Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg.
Reinders JS, Gouma DJ, Heisterkamp J, Tromp E, van Ramshorst B, Boerma D. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography. HPB (Oxford).
Byrne MF, McLoughlin MT, Mitchell RM, Gerke H, Kim K, Pappas TN, Branch MS, Jowell PS, Baillie J. For patients with predicted low risk for choledocholithiasis undergoing laparoscopic cholecystectomy, selective intraoperative cholangiography and postoperative endoscopic retrograde cholangiopancreatography is an effective strategy to limit unnecessary procedures. Surg Endosc.
Clayton ES, Connor S, Alexakis N, Leandros E. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg.
Deslandres E, Gagner M, Pomp A, Rheault M, Leduc R, Clermont R, Gratton J, Bernard EJ. Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy. Gastrointest Endosc.
Mayrhofer T, Schmiederer R, Razek P. Intraoperative endoscopic papillotomy and stone removal. Endosc Surg Allied Technol.
Feretis C, Kalliakmanis B, Benakis P, Apostolidis N. Laparoscopic transcystic papillotomy under endoscopic control for bile duct stones. Endoscopy.
Tekin A, Ogetman Z, Altunel E. Laparoendoscopic “rendezvous” versus laparoscopic antegrade sphincterotomy for choledocholithiasis. Surgery.
Borzellino G, Rodella L, Saladino E, Catalano F, Politi L, Minicozzi A, Cordiano C. Treatment for retained [corrected] common bile duct stones during laparoscopic cholecystectomy: the rendezvous technique. Arch Surg.
Tommasi C, Bencini L, Bernini M, Naspetti R, Cavallina G, Manetti R, Talamucci L, Farsi M. Routine use of simultaneous laparoendoscopic approach in patients with confirmed gallbladder and bile duct stones: fit for laparoscopy fit for “rendezvous”. World J Surg.
La Greca G, Barbagallo F, Di Blasi M, Chisari A, Lombardo R, Bonaccorso R, Latteri S, Di Stefano A, Russello D. Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work. World J Gastroenterol.
Tringali A, Mutignani M, Milano A, Perri V, Costamagna G. No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy.
Cemachovic I, Letard JC, Begin GF, Rousseau D, Nivet JM. Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients. Endoscopy.
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.
La Greca G, Barbagallo F, Di Blasi M, Di Stefano M, Castello G, Gagliardo S, Latteri S, Russello D. Rendezvous technique versus endoscopic retrograde cholangiopancreatography to treat bile duct stones reduces endoscopic time and pancreatic damage. J Laparoendosc Adv Surg Tech A.
Rábago LR, Chico I, Collado D, Olivares A, Ortega A, Quintanilla E, Delgado M, Castro JL, Llorente R, Vazquez Echarri J. Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital. Surg Endosc.
Enochsson L, Lindberg B, Swahn F, Arnelo U. Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience. Surg Endosc.
Moore KB, Adrales GL, Mastrangelo MJ. Laparoscopic common bile duct exploration. Curr Surg.
Gholipour C, Shalchi RA, Abassi M. Efficacy and safety of early laparoscopic common bile duct exploration as primary procedure in acute cholangitis caused by common bile duct stones. J Laparoendosc Adv Surg Tech A.
Hanif F, Ahmed Z, Samie MA, Nassar AH. Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc.
Poulose BK, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc.
Herrero A, Philippe C, Guillon F, Millat B, Borie F. Does the surgeon’s experience influence the outcome of laparoscopic treatment of common bile duct stones?. Surg Endosc.
Yin Z, Xu K, Sun J, Zhang J, Xiao Z, Wang J, Niu H, Zhao Q, Lin S, Li Y. Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg.
Tzovaras G, Baloyiannis I, Kapsoritakis A, Psychos A, Paroutoglou G, Potamianos S. Laparoendoscopic rendezvous: an effective alternative to a failed preoperative ERCP in patients with cholecystocholedocholithiasis. Surg Endosc.
Tandan M, Reddy DN. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones. World J Gastroenterol.
Stefanidis G, Christodoulou C, Manolakopoulos S, Chuttani R. Endoscopic extraction of large common bile duct stones: A review article. World J Gastrointest Endosc.
Yang J, Peng JY, Chen W. Endoscopic biliary stenting for irretrievable common bile duct stones: Indications, advantages, disadvantages, and follow-up results. Surgeon.
Topal B, Vromman K, Aerts R, Verslype C, Van Steenbergen W, Penninckx F. Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc.
Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev.
Costi R, Mazzeo A, Tartamella F, Manceau C, Vacher B, Valverde A. Cholecystocholedocholithiasis: a case-control study comparing the short- and long-term outcomes for a “laparoscopy-first” attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy). Surg Endosc.
Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO. Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc.
Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol.
Bansal VK, Misra MC, Garg P, Prabhu M. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc.
Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, Mackersie RC, Rodas A, Kreuwel HT, Harris HW. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg.
Wang B, Guo Z, Liu Z, Wang Y, Si Y, Zhu Y, Jin M. Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones: system review and meta-analysis. Surg Endosc.
Alexakis N, Connor S. Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB (Oxford).
Arezzo A, Vettoretto N, Famiglietti F, Moja L, Morino M. Laparoendoscopic rendezvous reduces perioperative morbidity and risk of pancreatitis. Surg Endosc.
ElGeidie AA, ElEbidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc.
Rábago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I, Castro JL, Quintanilla E, Romeo J, Llorente R. 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.
Hong DF, Xin Y, Chen DW. Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc.
Wei Q, Wang JG, Li LB, Li JD. Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy. World J Gastroenterol.
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.