Prior and Repeated ERCP Increase Difficulty of Subsequent Laparoscopic Cholecystectomy: Study
Researchers have found in a new study that previous ERCP is associated with greater operative difficulty during subsequent laparoscopic cholecystectomy. The risk appears to increase with repeated ERCP procedures, with three or more preoperative interventions linked to a higher likelihood of requiring laparoscopic subtotal cholecystectomy. These findings suggest that the cumulative burden of ERCP may contribute to increased surgical complexity. The study was published in the BMC Surgery by Yasir M. and colleagues.
For a rigorous evaluation of the influence of previous ERCP exposure on operative results, 426 patients undergoing laparoscopic cholecystectomy surgery were assessed retrospectively. Subjects were divided into those with ERCP and those without ERCP exposure. In order to avoid any bias in terms of demographics and clinical profiles among subjects, the researchers conducted 1:1 propensity score matching (PSM), adjusting for age, gender, and ASA physical status.
After conducting the PSM, the perioperative results of both sets were compared in order to assess the effect of ERCP alone. In addition, subgroups were studied within the ERCP group based on factors such as reason for ERCP, time interval from ERCP to LC, number of ERCPs, stone removal difficulty, and biliary stenting.
Key findings:
- Following 1:1 propensity score matching, there was a significantly higher need for LSC in the ERCP-exposed group when compared to the matched non-ERCP controls (P = 0.003).
- The incidence of conversion from laparoscopy to open cholecystectomy was not statistically different between the exposed and unexposed groups (P = 0.996).
- Among the patients in the ERCP-exposed group, those who had undergone 3 or more preoperative ERCPs showed a significantly increased incidence of LSC (P = 0.004).
- Placing 2 or more biliary stents was significantly associated with increased LSC rates (P = 0.008).
- Subgroup analysis revealed that multiple stone extractions during ERCP significantly increased the total laparoscopic operative time.
- In multivariate regression analysis, the occurrence of 3 or more preoperative ERCP procedures was significantly associated with an odds ratio (OR) of LSC of 15.98 (95% CI, 2.70-94.39; P = 0.002) even after controlling for confounders.
- Sensitivity analysis with fewer covariates in the model showed that multiple ERCP interventions were significantly associated with LSC.
It can be stated that prior ERCP makes subsequent laparoscopic cholecystectomy more difficult due to the increase in the need for subtotal resection. The results of this study demonstrate that accumulated exposure to ERCP, particularly those who have had three or more ERCP prior to surgery or several biliary stents, is the main reason behind surgical complexity. It is very important to avoid repeat endoscopic treatments and properly choose the time for surgery.
Reference:
Kesgin, Y.M., Gumusoglu, A.Y., Kabuli, H.A. et al. Effect of ERCP burden on outcomes of subsequent laparoscopic cholecystectomy. BMC Surg (2026). https://doi.org/10.1186/s12893-026-04135-0
