Endoscopic Retrograde Cholangiopancreatography Versus Laparoscopic Transcystic Balloon Dilatation of Papilla Vateri in Patients with Choledocholithiasis

Two-step therapy, endoscopic retrograde cholangiopancreatography with papillotomy and stone evacuation from common bile duct (CBD), and laparoscopic cholecystectomy (ERCP/LC) is standard treatment of choledocholithiasis and acute cholecystitis in our hospital, Rīga East University Hospital Gaiļezers. The one-step method, LC with intraoperative transcystic balloon dilatation of the papilla Vateri and anterograde evacuation of gallstones to duodenum (BD/LC), has been introduced in our hospital. The aim of this study was to compare two-step and BD/LC methods and report the outcomes from hospital’s clinical experience. A retrospective, comparative study was done from 01.2021 to 10.2023. Patients with acute calculous cholecystitis and choledocholithiasis with gallstone diameter in CBD cm, ASA score I-III were included. Gallstone’s diameter and number, hospitalisation time, and success rate were analysed. A total of 95 patients were included in our study, of which 46 patients underwent BD/LC and in 49 patients ERCP/LC was used. Median diameter of gallstones in the CBD was 6.1 mm in BD/LC and 6.3 mm in the ERCP/LC group (p = 0.38). Median hospitalisation time for patients with single-step treatment was seven days, and two-step therapy — 14 days (p = 0.001). The complication rate in BD/LS was 4.34% but in ERCP/LC group — 10.2% after ERCP (p = 0.049). The success rate in BD/LC was 95.6% and in ERCP/LC group — 89.6% (p = 0.145). BD/LC is associated with a shorter hospitalisation time, similar success rate and lower complication rate compared with an ERCP/LC.