Comparison of one-stage endoscopic retrograde cholangiopancreatography and cholecystectomy versus two-stage endoscopic retrograde cholangiopancreatography and cholecystectomy for treatment of cholelithiasis with choledocholithiasis

Introduction
The optimal management of symptomatic or suspected common bile duct (CBD) stone continues to be controversial despite the fact that laparoscopic cholecystectomy (LC) has turned out to be the standard method for gallbladder removal and despite innovations in endoscopy and laparoscopic surgery.
Aim
The aim of this study was to compare the two-stage intervention [endoscopic retrograde cholangiopancreatography (ERCP) under total intravenous anesthesia followed by interval LC] with the one-stage intervention (ERCP combined with LC) in terms of feasibility, safety, effectiveness, and hospital stay.
Patients and methods
Eighty patients admitted to the Medical Research Institute, University of Alexandria, during the interval between January 2012 and January 2013, diagnosed as having cholelithiasis with choledocholithiasis proven by laboratory and radiological investigations (abdominal ultrasonography and/or MRCP), were studied prospectively, and they were classified into two equal groups: group A, in which a two-stage procedure was performed; and group B, in which a one-stage procedure was performed. Data were recorded, including patients’ demographic, endoscopic, and operative details, success rate, postoperative complication (ERCP and LC), overall operative time, and length of hospital stay.
Results
The operative time was significantly lower in the two-stage group (group A). There were no statistically significant differences between both groups as regards CBD stone retrieval, morbidity rates, or the mean hospital stay.
Conclusion
Taking in consideration that our results showed no statistical difference between the two groups, there is still no gold standard of care for patients having chronic calcular cholecystitis and CBD stones. We prefer separating the two procedures in our routine practice.