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Abstract：
BACKGROUND: Single-session endoscopic stone extraction (ESE) and laparoscopic cholecystectomy (LC) has the best outcome in managing concomitant cholelithiasis (gallstone disease [GSD]) and choledocholithiasis (common bile duct stone [CBDS]). Traditional rendezvous technique with an intraoperative cholangiogram is associated with various technical (bowel distention, frozen Calot\'s triangle, limitation of intraoperative cholangiogram and so on) and logistical difficulties (lack of trained personnel and equipment for ESE in the operating room). We modified our approach of ESE-LC (tandem ESE-LC) to study the safety of the approach and overcome these disadvantages of the traditional rendezvous approach.
METHODS: A prospective study of patients with GSD and suspected CBDS from January 2017 to December 2019 was conducted. Tandem ESE-LC involves ESE and LC under the same general anaesthesia in a single day, while ESE is performed in the endoscopic suite using carbon dioxide insufflation, a balloon/basket was used for achieving bile duct clearance and the same was confirmed with an occlusion cholangiogram. Patients were then shifted to the operating room for LC. The primary outcome included bile duct clearance and safety of the procedure.
RESULTS: Of 56 patients assessed for eligibility, 42 were included in the study (median age: 53 years, 25 [60%] women). Biliary colic was the most common presenting symptom (n = 24, 57%), followed by acute cholecystitis (n = 11, 26%). The median number of stones and stone size was 1 (1-6) and 4 mm (3-10), respectively. All patients had successful bile duct clearance. Stenting was performed in 5 (12%) patients. Intraoperatively, Calot\'s dissection was difficult and frozen in 10 and 11 patients respectively. The cystic duct was short and wide in 13 (31%) patients. Subtotal cholecystectomy was performed in 6 (14%) patients. The median duration of postprocedural hospital stay was 1 (0-13) day. Three patients had tandem ESE-LC on a day-care basis. One patient had post-endoscopic retrograde cholangiopancretography pancreatitis, and another required percutaneous drainage for gall bladder fossa collection. No patient had retained CBDS at a median follow-up of 18 (3-28) months.
CONCLUSIONS: Tandem ESE-LC is safe and effective method in managing concomitant GSD and CBDS.
METHODS: A prospective study of patients with GSD and suspected CBDS from January 2017 to December 2019 was conducted. Tandem ESE-LC involves ESE and LC under the same general anaesthesia in a single day, while ESE is performed in the endoscopic suite using carbon dioxide insufflation, a balloon/basket was used for achieving bile duct clearance and the same was confirmed with an occlusion cholangiogram. Patients were then shifted to the operating room for LC. The primary outcome included bile duct clearance and safety of the procedure.
RESULTS: Of 56 patients assessed for eligibility, 42 were included in the study (median age: 53 years, 25 [60%] women). Biliary colic was the most common presenting symptom (n = 24, 57%), followed by acute cholecystitis (n = 11, 26%). The median number of stones and stone size was 1 (1-6) and 4 mm (3-10), respectively. All patients had successful bile duct clearance. Stenting was performed in 5 (12%) patients. Intraoperatively, Calot\'s dissection was difficult and frozen in 10 and 11 patients respectively. The cystic duct was short and wide in 13 (31%) patients. Subtotal cholecystectomy was performed in 6 (14%) patients. The median duration of postprocedural hospital stay was 1 (0-13) day. Three patients had tandem ESE-LC on a day-care basis. One patient had post-endoscopic retrograde cholangiopancretography pancreatitis, and another required percutaneous drainage for gall bladder fossa collection. No patient had retained CBDS at a median follow-up of 18 (3-28) months.
CONCLUSIONS: Tandem ESE-LC is safe and effective method in managing concomitant GSD and CBDS.
摘要：
背景：单次内镜取石（ESE）和腹腔镜胆囊切除术（LC）在治疗合并胆石症（胆石症[GSD]）和胆总管结石（胆总管结石[CBDS]）方面效果最佳。术中胆管造影的传统会合技术与各种技术（肠扩张，冷冻卡洛的三角形,术中胆管造影等方面的限制）和后勤困难（手术室缺乏经过培训的ESE人员和设备）。我们修改了ESE-LC（串联ESE-LC）的方法，以研究该方法的安全性，并克服了传统会合方法的这些缺点。
方法：对2017年1月至2019年12月GSD和疑似CBDS患者进行前瞻性研究。串联ESE-LC包括ESE和LC在相同的全身麻醉下，而ESE是在内窥镜套件中使用二氧化碳吹气进行的，使用球囊/篮来实现胆管清除，并且通过闭塞胆管造影证实了这一点。然后将患者转移到手术室进行LC。主要结果包括胆管清除和手术安全性。
结果：在评估合格的56名患者中，42人被纳入研究(平均年龄：53岁，25[60%]女性)。胆绞痛是最常见的症状（n=24，57%），其次是急性胆囊炎（n=11，26％）。结石数量和结石大小的中位数为1（1-6）和4毫米（3-10），分别。所有患者均成功清除胆管。5例（12％）患者进行了支架植入。术中,Calot的解剖困难，分别在10例和11例患者中冻结。13例（31％）患者的胆囊管短而宽。6例（14％）患者进行了胆囊次全切除术。术后住院时间中位数为1（0-13）天。三名患者在日托基础上进行了串联ESE-LC。1例患者经内镜逆行胰胆管造影术后胰腺炎,另一个需要经皮引流来收集胆囊窝。在18（3-28）个月的中位随访中，没有患者保留CBDS。
结论：串联ESE-LC是治疗合并GSD和CBDS的安全有效方法。
方法：对2017年1月至2019年12月GSD和疑似CBDS患者进行前瞻性研究。串联ESE-LC包括ESE和LC在相同的全身麻醉下，而ESE是在内窥镜套件中使用二氧化碳吹气进行的，使用球囊/篮来实现胆管清除，并且通过闭塞胆管造影证实了这一点。然后将患者转移到手术室进行LC。主要结果包括胆管清除和手术安全性。
结果：在评估合格的56名患者中，42人被纳入研究(平均年龄：53岁，25[60%]女性)。胆绞痛是最常见的症状（n=24，57%），其次是急性胆囊炎（n=11，26％）。结石数量和结石大小的中位数为1（1-6）和4毫米（3-10），分别。所有患者均成功清除胆管。5例（12％）患者进行了支架植入。术中,Calot的解剖困难，分别在10例和11例患者中冻结。13例（31％）患者的胆囊管短而宽。6例（14％）患者进行了胆囊次全切除术。术后住院时间中位数为1（0-13）天。三名患者在日托基础上进行了串联ESE-LC。1例患者经内镜逆行胰胆管造影术后胰腺炎,另一个需要经皮引流来收集胆囊窝。在18（3-28）个月的中位随访中，没有患者保留CBDS。
结论：串联ESE-LC是治疗合并GSD和CBDS的安全有效方法。
