Comparative Study of Dual-Modality Endoscopic Surgery in Elderly Patients With Emergency Common Bile Duct Stone Complicated With Gallbladder Stones-Clinical Application Analysis of ERCP Combined With LC Versus LCBDE+LC.

Abstract

Aim: To compare and analyze the clinical efficacy of two surgical approaches, endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE)+LC, in the treatment of emergency common bile duct stones, providing evidence-based support for individualized clinical surgical selection.

Methods: A retrospective analysis was conducted on 103 patients with emergency common bile duct stones complicated by gallbladder stones admitted between December 2016 and January 2023. The patients were divided into an ERCP+LC group (n = 56) and an LCBDE+LC group (n = 47). Surgical indicators, postoperative recovery, complications (Clavien-Dindo grade), and mid-term recurrence rates (1 and 1.5 years postoperatively), were compared between the two groups. Age and American Society of Anesthesiologists (ASA) classification were included as covariates in the multivariate Cox regression model, and multivariate logistic regression was performed to adjust for preoperative pancreatitis and evaluate its effects on operative time, postoperative complications and recurrence rate.

Results: The ERCP+LC group demonstrated significantly better intraoperative blood loss (15.00 (10.00-25.00) mL) and operative time (64.11 ± 26.64 min) compared to the LCBDE+LC group (30.00 (20.00-42.50) mL and 116.11 ± 29.69 min, respectively), but with higher hospitalization costs (p < 0.001). The LCBDE+LC group showed higher clearance rates for mid-common bile duct stones (n = 41, 87.23%) and sandy stones (n = 38, 80.85%) (p = 0.008; p = 0.010), and due to the preservation of the Oddi sphincter, the mid-term recurrence rates at 1 year and 1.5 years postoperatively were lower than those in the ERCP+LC group, although the differences were not statistically significant. High-risk patients (e.g., those with advanced age combined with severe comorbidities or ASA classification ≥ III) demonstrated comparable safety and perioperative recovery profiles between the two procedures (with identical complication rates of 9.1% and p > 0.05 for recovery time and hospital stay), while the ERCP+LC group exhibited a significantly shorter single-session operative time (p < 0.001).

Conclusions: Both approaches are effective treatments. ERCP+LC offers a shorter single-session operative time while maintaining a safety profile comparable to LCBDE+LC, making it a suitable option for high-risk patients sensitive to prolonged surgical stress, while LCBDE+LC offers more thorough stone clearance and better mid-term control of recurrence. Clinical decisions should consider stone characteristics, patient conditions, and hospital technical capabilities to develop individualized treatment strategies.