Recurrence of Gallstone Related Disease Following ERCP and Sphincterotomy for Common Bile Duct Stones Prior to Laparoscopic Cholecystectomy: Retrospective Analysis of a Single District General Hospital

Aims Conditions caused by gallstones migrating to the common bile duct (CBD) are the most common indication for ERCP. The NICE guidance ‘Gallstone disease: diagnosis and management’’ [1] reports no consensus on whether laparoscopic cholecystectomy (LC) should be performed within 2 weeks or after 6 weeks of index ERCP for CBD stones. The aim of this study was to determine the probability of a recurrent gallstone event following ERCP and sphincterotomy (ERCP ST) in patients who did not have prior LC and to determine the interval from index ERCP at which it occurs.

Methods This retrospective analysis reviewed ERCP procedures performed between 1/1/2022 and 31/12/2023 in a single District General Hospital. We included patients who had ERCP ST for complications of gallstones and did not have LC prior to index ERCP. We reviewed medical records and collected data on whether they suffered any recurrent gallstone related events post index ERCP. We followed up patients to the date of LC or until 8/11/2024 if they did not have LC.

Results The total of 142 patients were included (54% female, 46% male). The median age was 73 (24-93). Eight (6%) died of causes unrelated to gallstone disease during the follow up period. The indications for index ERCP were symptomatic CBD stones (62%), cholangitis (20%), pancreatitis (11%) and asymptomatic CBD stones (7%). All patients had a sphincterotomy. Clear cholangiogram at the end of ERCP was obtained in 93%. Six (4%) suffered a post ERCP complication. 63 (44%) patients had LC post ERCP. The median time from ERCP to cholecystectomy was 89 days (2-571). For those who did not have LC the median time of follow up was 647 days (131-1039). 17 out of 142 (12%) suffered from further episodes of gallstone disease after the index ERCP. Seven (41%) had symptomatic CBD stones, five (29%) developed cholecystitis, three (18%) cholangitis, two (12%) asymptomatic CBD stones. 11 (65%) required one hospital admission, four (23%) required two admissions and two (12%) were managed as outpatients. The median length of stay for patients with the recurrent disease was 9 days (3-22 days). Ten (59%) underwent repeat ERCP, five (29%) were treated with antibiotics alone, one (6%) had emergency LC, one (6%) was managed with watch and wait strategy. Seven (41%) underwent elective LC (median 59 days, 22-432). The median time from index ERCP to developing a gallstone complication was 86 days and ranged from 11 to 592. Five (29%) developed a recurrent gallstone event within 6 weeks. There was no difference between the age and gender of patients who developed recurrent disease compared to those who did not.

Conclusions The probability of developing a gallstone event following ERCP ST for CBD stones was 8% per year. In this study, 3.5% of patients suffered from a recurrent event within the first six weeks. Fit patients should be offered early LC, ideally within 2 weeks of index ERCP to prevent further episodes of gallstone related events.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Gallstone disease: diagnosis and management 2014 www.nice.org.uk/guidance/cg188

Publication History

Article published online:
27 March 2025