Intra-Operative Endoscopic Sphincterotomy: State of the Art

Context: Different approaches are routinely applied in the treatment of concomitant cholecystocholedocholithiasis. Most patients are treated by preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy in a two-stage approach. However one-stage approach carrying out intraoperative endoscopic sphincterotomy (IOES) is emerging as a minimally invasive alternative option. Our review evaluates the outcomes and potential advantages of IOES compared to the other therapeutic options..Evidence Acquisition: An accurate enquiry for papers relating to IOES and the different available options was performed on different medical databases. Endpoints considered were: successful clearance of common bile duct stones, overall complication rate, procedure related morbidity, conversion rate, duration of hospital stay and costs.. Data were collected from 21 scientific papers including: 5 prospective randomized clinical trial, 4 Meta-analysis and 12 case series. Similar rates of successful clearance of common bile duct stones were reported between Intra Operative Endoscopic Sphincterotomy (IOES) and Pre Operative Endoscopic Sphincterotomy (POES) (96.9% versus 96.3). Overall morbidity showed no statistical significant differences between the two approaches (16.1% in two stage approach versus 19.9% in one stage approach). IOES resulted superior to two-stage approach regarding duration of hospital stay with a mean difference of 2.83 days. The shorter hospital stay ensued in a reduction of cost in most studies. No differences in conversion rate were observed between POES and IOES (3.8% versus 3.7%).. Intraoperative endoscopic retrograde cholangiography is a safe, effective and feasible treatment for patients with concomitant gallbladder stones and choledocholithiasis. This review highlighted the advantages of IOES as a minimally invasive, one-stage approach. However in order to guarantee the success of such approach a profound collaboration between surgeon and endoscopist is mandatory and an efficient logistic organization of the operating theatre is needed..