Tsiopoulos Fotios, Kapsoritakis Andreas, Psychos Athanassios, Manolakis Anastasios, Oikonomou Konstantinos, Tzovaras George, Baloyiannis Ioannis, Tsikrika Alexandra, Potamianos Spyros
Department of Gastroenterology (Fotios Tsiopoulos, Andreas Kapsoritakis, Athanassios Psychos, Anastasios Manolakis, Konstantinos Oikonomou, Spyros Potamianos), Greece.
Department of Surgery (George Tzovaras, Ioannis Baloyiannis), Greece.
Ann Gastroenterol. 2018 Jan-Feb;31(1):102-108. doi: 10.20524/aog.2017.0210. Epub 2017 Nov 2.
Endoscopic retrograde cholangiopancreatography (ERCP), followed by laparoscopic cholecystectomy (LC), remains the standard way of management for patients with cholecystocholedocholithiasis. Laparoendoscopic rendezvous (LERV), a combined procedure for removing the gallbladder laparoscopically and clearing the common bile duct (CBD) endoscopically at the same time, could be an attractive alternative. The aim of this study was to compare LERV with classic ERCP in patients with cholecystocholedocholithiasis.
886 patients with cholecystocholedocholithiasis were treated either with the LERV technique (90 patients), or with the 2-stage approach, which includes preoperative ERCP followed by LC (796 patients). The primary endpoint was any difference in the success of CBD cannulation and clearance; secondary endpoints were the detection of differences in morbidity (especially post-ERCP pancreatitis [PEP]), and the feasibility of the two approaches.
Successful cannulation of the CBD was more frequent with conventional ERCP compared with the LERV technique (89.8% vs. 75.5%, P=0.0001). LERV appears to be as effective as conventional ERCP for complete CBD clearance (85.5% vs. 82.8%, P<0.1). None of the patients in the LERV group had an episode of clinical PEP, whereas in the conventional ERCP group there were 23 episodes of PEP and one death. The median amylase level was higher in patients undergoing conventional ERCP group compared to patients in LERV group.
Classic ERCP has a higher rate of successful CBD cannulation and a similar rate of CBD clearance compared to LERV.
内镜逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）仍是胆囊胆总管结石患者的标准治疗方法。腹腔镜内镜会师术（LERV）是一种同时通过腹腔镜切除胆囊和内镜清除胆总管（CBD）的联合手术，可能是一种有吸引力的替代方法。本研究的目的是比较LERV与经典ERCP在胆囊胆总管结石患者中的疗效。
886例胆囊胆总管结石患者分别采用LERV技术治疗（90例）或两阶段方法治疗，即术前ERCP后行LC（796例）。主要终点是CBD插管和清除成功与否的差异；次要终点是发病率差异（尤其是ERCP后胰腺炎[PEP]）的检测以及两种方法的可行性。
与LERV技术相比，传统ERCP成功插管CBD的频率更高（89.8%对75.5%，P=0.0001）。LERV在完全清除CBD方面似乎与传统ERCP一样有效（85.5%对82.8%，P<0.1）。LERV组患者均未发生临床PEP，而传统ERCP组有23例PEP发作和1例死亡。传统ERCP组患者的淀粉酶中位数水平高于LERV组患者。
与LERV相比，经典ERCP的CBD插管成功率更高，CBD清除率相似。
