Optimal timing of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a multicenter retrospective analysis

Abstract

To compare the clinical outcomes of ERCP combined with laparoscopic LC using both one-step and two-step approaches for the treatment of cholecystocholedocholithiasis, and to investigate the optimal timing for performing LC within two weeks after ERCP. The clinical data of 520 patients with cholecystocholedocholithiasis who were treated with ERCP and LC between January 2018 and December 2023 were retrospectively analyzed. Those who underwent ERCP and LC simultaneously with a single anesthesia constituted the one-step group ( n = 60), whereas those who had ERCP and LC in separate sessions were categorized as the two-step group ( n = 460), patients in the one-step approach group and the two-step approach group were matched using 1:4 propensity score matching (PSM). After PSM, the one-step approach group comprised 58 cases, and the two-step approach group comprised 218 cases. The 460 patients in the two-step group were further divided into three subgroups: ≤24 h group ( n = 186), 24–72 h group ( n = 187), and 72 h-2w group ( n = 87). We compared general patient information, preoperative laboratory indexes, imaging data, intraoperative conditions, and postoperative outcomes between the one-step and two-step groups, as well as among the three subgroups of the two-step method. An ordinal logistic regression model was used to evaluate the effect of ERCP-related complications occurring before LC on LC timing, and a sensitivity analysis was performed to validate the robustness of the findings. The one-step approach group exhibited significantly shorter hospital stays (7 vs. 9 days, P < 0.001) and lower hospital costs (29,703 vs. 33039rmb, P = 0.002) than the two-step approach group; The 72 h-2w group exhibited a longer length of stay (11vs.8vs.9days, P < 0.001), higher hospitalization costs (36810vs.32264vs.31556rmb, P < 0.001), a greater overall complication rate after ERCP (18.4%vs.5.9%vs.7.5%, P = 0.002), and an increased incidence of cholecystitis after ERCP (8%vs.0%vs.0%, P < 0.001) compared to the ≤ 24 h group and the 24–72 h group. Ordinal logistic regression identified ERCP‑related complications occurring before LC as an independent predictor of delayed LC (OR = 0.338, P = 0.001) ; sensitivity analysis excluding these patients showed consistent trends across groups. One-step management of cholecystocholedocholithiasis results in a shorter hospitalization duration and reduced costs. In a two-step approach, LC should be performed within 72 h following ERCP.