Endoscopic Bile Duct Clearance Followed by Same-Day Cholecystectomy: a Case Series Analysis

Early laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangio-pancreaticography (ERCP) is beneficial for patients with gall stone disease (GSD) and common bile duct (CBD) stones. However, there are no clear guidelines for the optimal timing of surgical intervention. This study aimed to assess the feasibility and clinical outcomes of the same-day sequential approach-ERCP followed by LC for management of choledocholithiasis and concomitant cholelithiasis. Between March 2018 and November 2019, 24 patients diagnosed with choledocholithiasis and concomitant cholelithiasis underwent ERCP-guided biliary clearance followed by LC sequentially on the same day. ERCP was done in the endoscopy suite and followed by LC in the operation theatre. Both procedures were performed by the same endoscopist-cum-laparoscopic surgeon proficient in advanced endoscopy and laparoscopy. Success rate, ERCP findings, operative findings, logistic issues, and complications were recorded and analysed. Technical success for ERCP and LC, both were 100%. No major complications like bleeding, perforation, pancreatitis, or mortality were encountered post-ERCP. The rate of conversion to open cholecystectomy was 0%. Post-operative self-resolving minor bile leak was encountered in 1 patient (4.1%) who was managed conservatively. The mean time for ERCP and LC was 33.33 min and 80.4 min, respectively. The mean time interval between the two procedures was 51 min. The mean post-procedure hospital stay was 3.7 days. This study demonstrated a safe, effective, and feasible same-day sequential approach-ERCP-guided biliary clearance followed by LC-in selected patients with choledocholithiasis with concomitant cholelithiasis.