SSAT - Predictors of Surgical Complexity in the Treatment of Choledocholithiasis: Number of ERCP Attempts and CBD Diameter Matter

Back to 2014 Annual Meeting Posters

Predictors of Surgical Complexity in the Treatment of Choledocholithiasis: Number of ERCP Attempts and CBD Diameter Matter
Holly Rochefort^*, Lea Matsuoka, Kostantinos Chouliaras, Didi Mwengela, James L. Buxbaum, Sophoclis Alexopoulos
Keck Medical Center of USC, Los Angeles, CA

Context: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used to clear the common bile duct (CBD) in patients with choledocholithiasis. While a single ERCP is usually effective, many patients undergo multiple ERCP attempts before cholecystectomy.
Objective: To identify pre-operative factors predictive of surgical complexity beyond routine laparoscopic cholecystectomy (LC) after ERCP.
Design/Setting: Data was prospectively collected for all ERCPs between 4/2010 and 2/2012 at a public academic medical center including: demographics, indication, stone presence, CBD diameter, sphincterotomy, stent placement, and ERCP number.
Patients: 73 patients meeting inclusion criteria underwent ERCP for choledocholithiasis followed by cholecystectomy.
Main Outcome Measures: Need for surgical intervention beyond LC including open cholecystectomy, CBD exploration or hepaticojejunostomy.
Results: 124 ERCPs were attempted in 73 patients, 10% of whom presented with cholangitis. 56% of patients underwent 1 ERCP, while 16% required ≥ 3. LC was performed in 58 (79%) patients while 15 (21%) patients required more complex operations including 5 open common bile duct explorations and 1 hepaticojejunostomy. The likelihood of requiring more complex surgery correlated with increased number of ERCPs with an OR (95%CI) of 4.302(2.036-9.09), p=<0.001 for more than one ERCP. Increased CBD diameter also correlated with complex surgery with OR(95%CI) 1.315(1.04-1.662), p = 0.022.
Conclusions: The number of pre-operative ERCPs and CBD diameter in choledocholithiasis patients are strong predictors for necessity of more complex surgical treatment and referral to a hepatobiliary surgeon should be considered.

Back to 2014 Annual Meeting Posters