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Volume 09 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X Gastro Congress 2019
July 08-09, 2019
July 08-09, 2019 | Zurich, Switzerland
14th Euro-Global Gastroenterology Conference
ERCP and laparoscopic cholecystectomy as a single setting procedure, can it be done safely in peripheral
rural hospital?
Nabin Pokharel1,2 and Gaurav Katwal2
1Lumbini Medical College, Nepal
2National Academy of Medical Science Bir Hospital, Nepal
Background: The ideal management of cholecysto-choledocholithiasis is an open cholecystectomy (OC) with the
CBD exploration worldwide. The single setting 2-stage approach- Endoscopic retrograde cholangiopancreatography
(ERCP), sphincterotomy (EST) and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy
(LC) offers advantages, mainly by reducing the hospital stay and the morbidity.
Objective: To compare the ERCP + LC single setting approach with an OC with the CBD exploration for the
treatment of cholecysto-choledocholithiasis.
Methods: We included the retrospective review of the open procedure which was maintained database from
November 2012 onwards at our hospital and did a prospective study of the ERCP +LC procedure October 13 to
October 2015 at Lumbini Medical College and Teaching Hospital, Palpa, Lumbini. The open cases were our control
group. Patients with cholecysto-choledocholithiasis underwent 2-stage ERCP + LC in a single setting was compared
with the 2-stage OC with CBD exploration in a single setting approach. All the cases included in the study are
elective. The primary objective is to study the feasibility of the procedure, whereas secondary objectives are to 1).
Detect the morbidity (Post-ERCP, Cholangitis, Pancreatitis, Abdominal collection, Wound infection) 2). The length
of stay and 3). Stone clearance respectively. This is an interim analysis with 83 patients in ERCP + LC and 77 in open
group respectively.
Results: Hospital stay was significantly shorter in the ERCP + LC group; 3.92±0.719 days versus 10.30±1.557 days,
P<0.05. There was significant difference in total morbidity of ERCP + LC group 7(8.4%) vs. 14(18.2%), p-value<0.05,
where wound infection in ERCP + LC group was 2(2.4%) vs. 4(5.2%) and there was one case of abdominal collection1
(1.2%) which was managed symptomatically. The incidence of retained CBD stone in ERCP + LC was 3(1.2%) which
was managed successfully with ERCP. Post-ERCP amylase value was found within the normal limit in all the cases.
Conclusions: The analysis of our results suggests ERCP + LC in the settings of the peripheral hospital are feasible in
terms of cost, length of hospital stay, morbidity and stone clearance.
J Gastrointest Dig Syst 2019, Volume 09