Sequential intraluminal endoscopic and laparoscopic treatment for bile duct stones associated with gallstones.
BACKGROUND
On the basis of a flowchart including prior or current jaundice or pancreatitis, abnormal liver function, ultrasound or IV cholangiography, bile duct (BD) stones were suspected in 71/593 patients referred for gallstones.


METHODS
When endoscopic retrograde cholangiography detected BD stones, endoscopic sphincterotomy (ES) and endoscopic BD clearance were attempted, followed by laparoscopic cholecystectomy (LC). BD stones were found in 44/71 patients. The sensitivity values of preoperative conditions were: 92% for IV cholangiography, 88% for abnormal liver function, 50% for ultrasound, and 37% for jaundice at admission.


RESULTS
Endoscopic clearance succeeded in 37 patients and LC was completed in 33 patients. Conversion to open surgery (9%) was comparable with the rate in patients without BD stones. The median hospital stay for the sequential endoscopic and laparoscopic treatments was 13 days (range 4-54) or 22 days if open surgery was used.


CONCLUSIONS
In conclusion, BD stones can be endoscopically cleared preoperatively in most patients without interfering with LC.
Zaninotto
G
G
Department of Surgery, University of Padova School of Medicine, Istituto di Chirurgia Generale 2.
Costantini
M
M
Rossi
M
M
Anselmino
M
M
Pianalto
S
S
Oselladore
D
D
Pizzato
D
D
Norberto
L
L
Ancona
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed