Do Cholecystectomy First in Patients with Intermediate Risk for Choledocholithiasis

Current guidelines recommend preoperative endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) prior to cholecystectomy in patients with a high risk for concomitant choledocholithiasis (i.e., patients with cholangitis, jaundice, or a visible common bile duct [CBD] stone on noninvasive imaging). In patients with low risk for choledocholithiasis (i.e., patients with uncomplicated gallstone pancreatitis), proceeding directly to cholecystectomy is recommended, although preoperative ERCP continues to be utilized inappropriately in this setting. However, in patients with a moderate risk for CBD stones, most guidelines provide no specific treatment recommendations.

In the current trial, investigators randomized 100 p…