Su1518 EFFECT OF POST-ERCP CHOLECYSTECTOMY VS. PRIMARY ERCP ALONE ON THE RATE OF RECURRENT COMMON BILE DUCT STONES

Abstract

Gallstone diseases have a high prevalence in western populations and pose a large burden to health care systems. While endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment of choice for common bile duct stones (CBDS), post-ERCP cholecystectomy (CCY) is often performed to prevent recurrent gallstone disease. The effect of post-ERCP CCY compared to primary ERCP alone on the rate of recurrent CBDS has not been described in a general population over a prolonged period of time. Our aim was to investigate the effect of post-ERCP CCY compared to primary ERCP alone on the rate of recurrent CBDS during 5-year follow-up from time of intervention. Using an internal ERCP database at Odense University Hospital, we identified all patients that underwent ERCP for CBDS between January 1 1995 and August 31 2019. Patients with known hepatobiliary or pancreatic malignancies at the time of ERCP were excluded. Patient characteristics, clinical presentation and information on endoscopic procedures were retrieved from the ERCP database. Information on comorbidities, recurrent CBDS and performance of post-ERCP CCY were retrieved from the Danish National Patient Registry (in ICD-10 and SKS codes). The effect of post-ERCP CCY compared to ERCP alone on the rate of recurrent CBDS was investigated using logistic regression, with adjustment for age and comorbidities (Charlson Comorbidity Index, CCI). During the study period 1,768 consecutive patients that underwent ERCP for CBDS fulfilled the inclusion criteria. Among these, 635 patients received post-ERCP CCY (within half a year after primary ERCP) and 1,133 received ERCP alone. Differences between the CCY and no CCY group were observed in age (p<0.01) and gender (p<0.01). The rate of recurrent CBDS during 1-year follow-up was 16% (n=104) in the CCY group and 18% (n=209) in the no CCY group (p=0.30). During 5-year follow-up the rate of recurrent CBDS was 23% (n=149) in the CCY group and 21% (n=239) in the no CCY group (p=0.27). Neither age or gender were independently associated with risk for recurrent CBDS at 5-year follow-up (p>0.1 for both). Performance of CCY was not associated with reduced risk of recurrent CBDS during 5-year follow-up – in both univariate analysis (OR [95% CI]: 1.15 [0.91-1.45]; p=0.25) and multivariate analysis (OR [95% CI]: 1.07 [0.82-1.41]; p=0.61) after adjustment for age (OR [95% CI]: 1 [0.99-1.00]; p=0.51) and CCI (OR [95% CI]: 0.52 [0.27-0.97]; p=0.04). Our results indicate that post-ERCP CCY is not associated with reduced rates of recurrent CBDS compared to ERCP alone during a prolonged follow-up period of 5 years from the time of intervention.