Acute Pancreatitis (AP), Children, Cholangiopancreatography, Endoscopic Retrograde, Cholecystolithiasis, Choledocholithiasis, Common Bile Duct Calculi, Laparoscopic Cholecystectomy
Conditions
Keywords
Сholedocholelysis, Endoscopic retrograde cholangiopancreatography (ERCP)
Brief summary
In this study, it is planned to compare ERCP with ES + delayed LC in children, with one-stage LC + ERCP with ES in adults to confirm that ERCP with ES + delayed LC is more suitable for pediatric patients with cholecystocholedocholithiasis.
Detailed description
Nowadays there is no gold standard for the treatment of choledocholithiasis combined with cholecystolithiasis in the pediatric population. The most common method for resolving the biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC). In the adult practice, the approaches to the treatment of choledocholithiasis include the following items: laparoscopic common bile duct exploration (LCBDE), laparoendoscopic rendezvous method (LERV) and LC after ERCP. Both LCBDE and LERV allow for the simultaneous treatment of cholecystocholedocholithiasis. However, a great number of medical institutions do not have an opportunity to use these methods due to the difficulties of implementation and the need for special training and experience of specialists. The timing of LC after ERCP in patients with cholecystocholedocholithiasis also remains a subject of debate. Numerous studies recommend early LC after ERCP. However, there are high risks of injury to the common bile duct and hepatic vessels against the background of acute inflammatory process in the area of hepatoduodenal ligament. In this study, it is planned to compare ERCP with ES + delayed LC in children, with one-stage LC + ERCP with ES in adults to confirm that ERCP with ES + delayed LC is more suitable for pediatric patients with cholecystocholedocholithiasis. The aim of this study is to evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy with delayed laparoscopic cholecystectomy in children with cholecystocholedocholithiasis compared with one-stage cholangiopancreatography, endoscopic sphincterotomy and laparoscopic cholecystectomy in adults with cholecystocholedocholithiasis.
Interventions
PROCEDUREendoscopic retrograde cholangiopancreatography; laparoscopic cholecystectomy
Initially, ERCP with EST was performed by an endoscopist with the consent of the patient or legal representative. The patients underwent endoscopic procedures using fluoroscopy in the operating room, under general anesthesia. Subsequently, laparoscopic cholecystectomy was performed immediately after ERCP with ES under general anesthesia.
Initially, ERCP with EST was performed by an endoscopist with the consent of the patient or legal representative. The patient underwent the endoscopic procedure using fluoroscopy in the operating room, under general anesthesia. Subsequently, laparoscopic cholecystectomy was performed on a delayed basis no earlier than 7 days after ERCP
Sponsors
Moscow Regional Research and Clinical Institute (MONIKI)
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
0 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Informed consent from the patient, child or legal representative * Age 0-80 years * Acute cholecystitis * Choledocholithiasis * Intraoperative ERCP * Preoperative ERCP followed by cholecystectomy
Exclusion criteria
* Unwillingness or inability to consent to the study * Pregnancy * Age \> 80 years * Previous ERCP or percutaneous transhepatic biliary drainage * Anastomosis in the upper gastrointestinal tract * Benign or malignant stricture * Preoperative comorbidities: gastrointestinal bleeding, severe liver disease, acute and chronic cholangitis, other known cholestatic hepatopancreatobiliary disease, septic shock. * In combination with Mirizzi syndrome and intrahepatic bile duct stones * Congenital anomaly of the biliary tract * Malignant neoplasms * Acute pancreatitis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence of stones in the common bile duct | 30 days after ERCP | The diagnosis of the stone in the common bile duct. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perforation | 30 days after ERCP | by CT, radiography (fluid or gas in the retroperitoneal space or abdominal cavity, visual picture during endoscopic examination) |
| Bile leak | 30 days after ERCP | bile aspirated from the abdominal cavity |
| Acute cholangitis | 60 days after ERCP | intermittent chills, fever, increased proinflammatory blood markers after ERCP |
| Bile duct stricture | 1 year after ERCP | after ERCP |
| Bleeding | 30 days after ERCP | decreased hemoglobin level, visual picture during endoscopic examination, positive stool for occult blood |
| Technical success - success of the procedures as documented by a yes or no | 1 month | — |
| Duration of the laparoscopic cholecystectomy,min | From enrollment to the end of treatment (3 month) | — |
| Acute pancreatitis | within 14 days after ERCP | at least two out of three criteria according to the classification developed by the INSPPIRE group |
| Duration of the Endoscopic retrograde cholangiopancreatography | From enrollment to the end of treatment (3 month) | — |
| Time spent in hospital until discharge | from admission to hospital until the end of treatment (up to 8 weeks) | — |
Countries
Russia
Outcome results
None listed