One- or Two-Stage Procedures for Common Bile Duct Stone Disease?

Endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP/S) has traditionally been performed prior to laparoscopic cholecystectomy (LC) in patients with suspected choledocholithiasis. More recently, one-stage techniques — combination LC and laparoscopic common bile duct exploration (LC/LCBDE) — have been developed to treat these patients.

In a randomized prospective trial, investigators compared the use of one-stage LC/LCBDE with two-stage ERCP/S + LC in patients with symptomatic gallstone disease and likely choledocholithiasis based on ≥1 of the following criteria: common bile duct diameter ≥6 mm on ultrasound or computed tomography (CT), intrahepatic duct dilation on ultrasound or CT scan, serum bilirubin ≥2 mg/dL, or alkal…