ThTP1.1 Follow-Up of Young Patients Undergoing ERCP for Common Bile Duct Stones: Moving Algorithm Towards Surgery

Abstract

Abstract Background Historically, the default treatment for common bile duct (CBD) stones in our institution has been endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the clinical outcomes following ERCP performed for CBD stones in patients aged 35 years old and younger, who may have been suitable for single-stage cholecystectomy with CBD exploration instead. Methods A database of all patients undergoing ERCP from May 2015 to May 2022 in a tertiary institution was prospectively maintained. We identified patients aged 35 and under who received ERCP for CBD stones, and reviewed data on their demographics and clinical outcomes from electronic clinical records. Results A total of 4079 ERCPs were carried out with a post-ERCP pancreatitis rate of 4.3%. 124 patients aged 35 and under (mean age 29±4 years, 84.7% female) were selected for further analysis. They had a post-ERCP pancreatitis rate of 12.1%. 100 patients (80.6%) proceeded to definitive surgery, with a median waiting time of 76 days. Of these, 38.0% experienced an unplanned admission resulting in emergency laparoscopic cholecystectomy; a proportion required repeat ERCP and imaging. Consequently, these patients accumulated a total hospital stay of 13±8 days. Conclusions A higher rate of pancreatitis was seen in younger patients and a delay to definitive treatment is described, resulting in unplanned admissions, re-interventions and extra imaging with the associated increased cost. Single-stage cholecystectomy with CBD exploration would reduce complications, unplanned readmissions and cost. It is now our choice of treatment for CBD stones in this group of patients.