Laparoendoscopic rendezvous versus ERCP in the management of cholecystocholedocholithiasis: a cohort study

Aims Biliary stones are an endemic condition, affecting 20% of the population. In up to 20% of cases, gallstones are associated with common bile duct stones (CBDS), which may cause symptoms and complications. The management of CBDS is still controversial. The aim of our study is to compare the laparoendoscopic rendezvous (RV) with endoscopic retrograde cholangiopancreatography (ERCP) to treat cholecystocholedocholithiasis using a large cohort of patients.

Methods All patients who underwent laparoendoscopic RV or ERCP between January 2000 and August 2023 were identified from the local registry of Pescara Hospital. All patients were diagnosed preoperatively by MRCP or EUS. The primary endpoint was the rate of clearance of the CBD. Secondary endpoints were adverse events and the length of stay. Univariate and multivariate logistic regression adjusted for age and gender were used to investigate the association between treatment and outcomes.

Results A total of 706 patients were included. Of those, 228 were treated with RV and the remaining 478 with ERCP. When compared to patients treated with ERCP, those treated with RV were more likely to achieve complete resolution (87% vs 68%, P<0.001) and this association was confirmed after multivariate adjustment (OR 2.32, 95% CI 1-48-3.72). No differences were observed between the two groups in terms of postprocedural complications such as pancreatitis (0.5% vs 2.4%, P=0.2), bleeding (3.2% vs 2.4%, P=0.8) and perforation (0.5% vs 0%, P=0.9). As expected, the length of stay was longer in the RV group (MD 2.8 days; 95% CI 1.9-3-6).

Conclusions In this historical cohort study, we demonstrated that RV is highly effective, is associated with a higher rate of complete biliary clearance at the expense of a slightly longer hospital stay, which indeed includes cholecystectomy thus reducing overall costs. Moreover, RV is a safe procedure, the rate of complications is low and similar between the two groups. Finally, we can speculate that RV is more comfortable for patients, having cholecystectomy and CBD clearance in one session rather than two, and it is quicker, avoiding the cannulation trouble. These results support the adoption of the RV approach especially in low ERCP volume centers.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024