Intraoperative Endoscopic Retrograde Cholangiographies at Pasteur Hospital: A review of morbidity and mortality from 2016 to 2021
DOI:
https://doi.org/10.31837/cir.urug/9.1.6Keywords:
ERCP, intraoperative ERCP, rendezvous, combined procedureAbstract
Introduction: Management of common bile duct stones (CBD) involves multiple options. Techniques like laparoendoscopic rendezvous have improved clinical outcomes, reduced complications, and healthcare costs. This study examines the morbidity and mortality of intraoperative Endoscopic Retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomies.
Materials and Methods: A retrospective study was conducted assessing patients undergoing intraoperative ERCP plus laparoscopic cholecystectomy over a 6- year period. Data such as indication for procedure, findings, extraction methods, admission/discharge dates, complications and mortality were recorded. Results: Between 2016 and 2021, 468 ERCP procedures were performed, with 46 being intraoperative. Standard common bile duct cannulation was most common, with a smaller percentage being true rendezvous procedures. The therapeutic success rate was high, with a low complication rate. No complications like post-ERCP pancreatitis were recorded. Selective common bile duct cannulation via rendezvous is associated to lower rates of post-ERCP pancreatitis. There was no mortality in the series.
Conclusions: The combined procedure of intraoperative ERCP plus laparoscopic cholecystectomy is effective and safe, resolving both pathologies in a single intervention. With a high success rate and low morbidity, its main limitation lies in the need for available resources and coordination with specialized endoscopic teams in advance.
Downloads
References
Cavina E, Franceschi M, Sidoti F, Goletti O, Buccianti P, Chirugi M. Laparo-endoscopic “rendezvous”: a new technique in the choledocholithiasis treatment. Hepatogastroenterology. 1998;45(23):1430-5.
Piazze A, Ruocco A. Tratamiento de la litiasis residual del colédoco con drenaje biliar externo por papilotomía endoscópica guiada. Cir Uruguay. 1996;66: 99-103.
Yoo K, Lehman G. Endoscopic Managemente of Biliary Ductal Stones. Gastroenterol Clin North Am. 2010;39(2):209-27. doi: 10.1016/j.gtc.2010.02.008.
Alvarado GA, Hernández CJT, Álvarez MOA, Chávez AA, Lerma ARM, Arteaga VLR. et al. Colangiopancreatografía retrógrada endoscópica intraoperatoria como opción segura y eficaz para tratamiento de coledocolitiasis. Rev Mex Cir Endoscop. 2016;17(3):132-138.
Lei C, Lu T, Yang W, Yang M, Tian H, Song S, et al. 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;35:5918–5935. doi: 10.1007/s00464-021-08648-y
Vakayil V, Klinker ST, Sulciner ML, Mallick R, Trikudanathan G, Amateau SK, et al. Single-stage management of choledocholithiasis: intraoperative ERCP versus laparoscopic common bile duct exploration. Surg Endosc. 2020;34:4616–4625. doi: 10.1007/s00464-019-07215-w
Poh BR, Ho SP, Sritharan M, Yeong CC, Swan MP, Devonshire DA, et. al. Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis. Br J Surg. 2016;103(9):1117-24. doi: 10.1002/bjs.10207.
Barba Valadez CT, Barba Valadez LA, Gaitán Mercado CM, López Rodríguez JL. Tratamiento de la colecistocoledocolitiasis: colangiografía retrógrada endoscópica versus transoperatoria en el Hospital Manuel Hidalgo de Aguascalientes. Cir Gen. 2017;39 (2):93-100.
Bejarano M, Rodríguez-Holguín F, Palacios-Rodríguez HE, Delgado-Ocampo CE. Diagnóstico y tratamiento de coledocolitiasis con diferentes técnicas de imagen. Rev Colomb Cir.2022;37:135-8. doi: 10.30944/20117582.985
Al-Mansour MR, Fung EC, Jones EL, Zayan NE, Wetzel TD, Martin Del Campo SE, et al. Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers. Surg Endosc. 2018; 32(6): 2871–2876. doi: 10.1007/s00464-017-5995-x.
Álvarez-Chica LF, Rico-Juri JM, Carrero-Rivera SA, Castro-Villegas F. Coledocolitiasis y exploración laparoscópica de la vía biliar. Un estudio de cohorte. Rev Colomb Cir. 2021;36:301-11. doi: 10.30944/20117582.558
Laugier R, Grandval P. Endoscopic retrograde cholangiopancreatography. Endoscopy. 2011;43(11): 990–992. doi: 10.1055/s-0031-1291433.
Nielsen LBJ, Shabanzadeh DM, Aaresøn A, Sørensen LT. The clinical course of common bile duct stone clearance with endoscopic retrograde cholangio-pancreaticography. Scand J Gastroenterol. 2019;54(9):1166-1171. doi: 10.1080/00365521.2019.1663259.
Testoni P, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, et al. Papillary cannulation and sphincterotomy techniques at ERCP: ESGE Clinical Guideline. Endoscopy 2016;48(07):657-683. doi: 10.1055/s-0042-108641
Xiao L, Geng C, Li X, Li Y, Wang C. Comparable safety of ERCP in symptomatic and asymptomatic patients with common bile duct stones: a propensity-matched analysis. Scand J Gastroenterol. 2021;56(1):111-117. doi: 10.1080/00365521.2020.1853222.
Moreira E, Pontillo M, Hernández R, Rodríguez G. Tratamiento de la litiasis coledociana por vía laparoscópica, serie de casos de la Clínica Quirúrgica 2 del Hospital Maciel. Cir. Urug. 2020;4(1):5-13. doi: 10.31837/4.1.2
Pekolj J, Sendín R, Aldet A, Sívori JA, Santibañes E. Tratamiento de la litiasis coledociana por vía transcística laparoscópica: utilización y efectividad del método / Bile duct treatment by laparoscopic transcystic approach: used and method applicability. Rev. argent. cir. 1997;72(5):146-58.
Piazze A. Tratamiento endoscópico de la litiasis de la vía biliar principal En: Salom A, Piazze A. Tramiento miniinvasivo de la enfermedad litiásica de la Vía Biliar. Relato Oficial del 63 Congreso Uruguayo de Cirugía, Montevideo, 2012, p 97-9. doi: 10.31837/relatos/4
Lordello Passos M, Braga Ribeiro I, Turiani Hourneaux de Moura D, Korkischko N, Rodela Silva GL, Franzini TL, et al. Efficacy and safety of CO? versus air insufflation during ERCP in RCTs: A systematic Review and meta-análysis. Endosc Int Open. 2019;7(4):E487-E497. doi: 10.1055/a-0854-3739
Salom A, Miranda A, Pais C, Murias F, Giliberti B, Abiuso L, et al. Incidencia de litiasis vesicular asintomática en pacientes con complicaciones biliares. Servicio de Cirugía Asociación Española. Cir. Urug. 2022;6(1). doi: 10.31837/cir.urug/6.1.12
García Andrada D, Gil R, Granero L. El manejo de la litiasis coledociana en el siglo XXI. Relato oficial. XIX Congreso Argentino y Latinoamericano de Médicos Residentes de Cirugía General. Córdoba. Argentina. 2006. https://www.academia.edu/42683229/EL_MANEJO_DE_LA_LITIASIS_COLEDOCIANA_EN_EL_SIGLO_XXI
Garzón M, Hernández G, Pérez O, Martínez JD, Molano JC, Marulanda JC, et al. Factores asociados con el uso de litotripsia mecánica en pacientes con cálculos gigantes de la vía biliar: ¿puede la dilatación papilar con balón grande disminuir su requerimiento? Rev. colomb. Gastroenterol. 2017;32(3).202-208. doi: 10.22516/25007440.151
Kim TH, Kim JH, Seo DW, Lee DK, Reddy ND, Rerknimitr R, et al. International consensus guidelines for endoscopic papillary large-balloon dilatation. Gastrontest Endosc. 2016; 83 (1):37-47. doi: 10.1016/j.gie.2015.06.016
Li G, Pang Q, Zhang X, Dong H, Guo R, Zhai H, et al. Dilation-assisted stone extraction: an alternative method for removal of common bile duct stones. Dig Dis Sci. 2014;59:857-64. doi: 10.1007/s10620-013-2914-4
Jun Bo Q, Li Hua X, Tian Min C, Liu Gen G, Yan Mei Y, Hua Sheng L. Small Endoscopic Sphincterotomy plus Large-Balloon Dilation for Removal of Large Common Bile Duct Stones during ERCP. Pak J Med Sci. 2013 Jul;29(4):907-12. doi: 10.12669/pjms.294.3662.
Vázquez Reta JA, Vázquez Guerrero AR, Vázquez Guerrero AL. Rendezvous laparoendoscópico para el tratamiento de la colecistocoledocolitiasis. Cirujano General. 2012;34(3):189-193.
Tan C, Ocampo O, Ong R, Shi Tan K. Comparison of one stage laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of preoperatively diagnosed patients with common bile duct stones: a meta-analysis. Surg Endosc. 2018;32(2):770-778. doi: 10.1007/s00464-017-5739-y.
La Barba G, Gardini A, Cavargini E, Casadei A, Morgagni P, Bazzocchi F, et al. Laparoendoscopic rendezvous in the treatment of cholecystocholedocholitiasis: a single series of 200 patients. Surg Endosc. 2018;32:3868–3873. doi: 10.1007/s00464-018-6125-0
Baloyiannis I, Tzovaras G. Current Status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis. World J Gastrointest Endosc. 2015;7(7): 714-9. doi: 10.4253/wjge.v7.i7.714.
Tzovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, et al. Laparoendoscopic Rendezvous Versus Preoperative ERCP and Laparoscopic Cholecystectomy for the Management of Cholecysto-Choledocholithiasis. Ann Surg. 2012;255(3):435-9. doi: 10.1097/SLA.0b013e3182456ec0.
Bueno Lledó J, Ibáñez Cirión JL, Torregrosa Gallud A, López Andújar R, et al. Elaboración de un score predictivo preoperatorio de coledocolitiasis. Gastroenterol Hepatol. 2014;37(9):511-18. doi: 10.1016/j.gastrohep.2014.04.001
García Collantes E. et al. Complicaciones de la Colangiopancreatografía retrógrada Endoscópica (CPRE). Barakaldo. 2019:1-31.
Gallego-Rojo FJ, Gallardo-Sánchez F, Martínez-Cara JG. Complicaciones de la colangiopancreatrografía retrógrada endoscópica (cpre). Identificación, prevención y manejo. RAPD on line. 2010;33(1).
Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, et. al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32-47. doi: 10.1016/j.gie.2016.06.051.
Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54(4):425-34. doi: 10.1067/mge.2001.117550.
Sotelo JC, Sambresqui A, Ubeira R, Orbe G, Fernández JL, Ortiz N, et al. Efectividad de la indometacina rectal en la prevención de la pancratitis post colangiopancreatografía retrógrada endoscópica. Acta Gastroenterol Latinoam. 2018;48(2):131-137
Dumonceau Jean-Marc et al. ERCP-related adverse events: ESGE Guideline. Endoscopy. 2020;52(2):127-49. doi: 10.1055/a-1075-4080
Vettoretto N, Arezzo A, Famiglietti F, Cirocchi R, Moja L, Morino M. Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct. Cochrane Database Syst Rev. 2018;4(4):CD010507. doi: 10.1002/14651858.CD010507.pub2.
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles, videos and images published in Revista Cirugía del Uruguay are under the Creative Commons CC licenses, which is a complement to the traditional copyright, in the following terms: first, the authorship of the referred document must always be acknowledged and secondly none of the article or work published in the journal may have commercial purposes of any nature. The authors retain their copyrights and give the magazine the right of first publication of their work, which will be simultaneously subject to the Creative Commons Attribution-NonCommercial 4.0 International License license that allows the work to be shared whenever the initial publication is indicated in this journal.




















