To quantify completion and timeliness of definitive cholecystectomy after ERCP for bile duct stones (BDS), and downstream service utilisation, stratified by operative risk.
Retrospective service evaluation of consecutive adults undergoing index ERCP for BDS with gallbladder in situ (January 2023-December 2024) in two hospitals. Non-stone indications and prior cholecystectomy were excluded, and only the first ERCP per patient was analysed. Operative-risk strata were prespecified using ASA and Charlson: low (ASA 1–2 & Charlson 0–2), high (ASA 4–5 or Charlson ≥5), and medium otherwise. Definitive management was completed cholecystectomy after ERCP. Outcomes were completion, time to surgery (≤2 weeks; ≤12 weeks), and downstream readmissions, bed-days, and repeat ERCP.
356 patients (median age 72 years; 56.2% female) were included. Completed cholecystectomy occurred in 81/356 (22.8%; 95% CI 18.7%–27.4%); 4/356 (1.1%) had surgery attempted but not completed, and 21/356 (5.9%) were awaiting surgery at data-lock. Completion rates were 49/78 (62.8%) in low-risk, 30/141 (21.3%) in medium-risk, and 2/137 (1.5%) in high-risk patients. Among 80 patients with dated intervals, the median ERCP-to-cholecystectomy time was 104 days (IQR 49–224); surgery occurred within 2 weeks in 10/356 (2.8%) and within 12 weeks in 33/356 (9.3%). The cohort generated 122 biliary readmissions, 1087 bed-days, and 121 repeat ERCPs; patients without a completed cholecystectomy accounted for 61.5%, 67.2%, and 62.8%.
Definitive cholecystectomy after ERCP was infrequent and delayed, with a steep operative-risk gradient, and most downstream admissions, bed use, and repeat ERCP concentrated in patients without definitive management.
Makthum Muwafikha Ismail, Charlotte Smith, Stewart Campbell et al.· British Journal of Surgery· 0 citations
ERCP after laparoscopic cholecystectomy is uncommon but consequential, exposing patients to procedure-related morbidity and consuming endoscopy capacity. UK ERCP quality standards emphasise governance and audit of avoidable repeat procedures. Contemporary pooled data confirm ERCP adverse events remain clinically important. We quantified 90-day postoperative ERCP incidence and examined drivers relevant to pathway design; bile-leak indications are time-sensitive.
Retrospective cohort across three acute hospitals in one NHS health board (Jan 2023–Nov 2024). The primary outcome was the first ERCP ≤90 days. Secondary outcomes were ERCP ≤30 days, time to ERCP, and 30-day readmission. Logistic regression included age, non-elective surgery, recorded CBD stones, and subtotal cholecystectomy; sensitivity models adjusted for intraoperative cholangiography and CBD exploration.
792/794 operations had ascertainable 90-day ERCP status. ERCP ≤90 days occurred in 55/792 (6.9%, 95% CI 5.4–8.9) and ERCP ≤30 days in 39/792 (4.9%). Median time to ERCP was 10 days (IQR 4–44). Thirty-day readmission was higher among ERCP cases (25.5% vs 6.1%). Independent drivers were recorded CBD stones (aOR 6.14, 95% CI 3.35–11.25), subtotal cholecystectomy (aOR 7.47, 95% CI 3.79–14.70) and non-elective surgery (aOR 1.94, 95% CI 1.06–3.55); intraoperative cholangiography and CBD exploration were not independently associated.
Approximately 1 in 18 patients required ERCP within 90 days. Demand concentrates in stone-phenotype and subtotal cases, supporting risk-stratified follow-up and targeted pathway optimisation; ERCP is a marker of case-mix and pathway design.
Samantha Ng, K. Khan· British Journal of Surgery· 0 citations
Male sex is linked to conversion after laparoscopic cholecystectomy (LC); however, conversion is an imprecise surrogate for operative difficulty. We tested whether male sex predicts severe difficulty graded by the Nassar scale in a specialist biliary cohort.
We analysed prospectively maintained database of LC with or without laparoscopic common bile duct exploration (LCBDE), 1992–2023. The cohort only included cases with recorded sex and Nassar grade; severe difficulty was grade IV–V. Multivariable logistic regression adjusted for clinical, imaging, and operative covariates (LCBDE and era); performance was summarised using AUC and Brier score.
Among 6,129 procedures, 1,615 (26.3%) were male; men were older (median 57 vs 49 years) and more often emergency admissions (55.0% vs 44.1%) (both p<0.001). Severe difficulty occurred in 30.1% of men versus 12.8% of women (absolute difference 17.3%; unadjusted OR 2.93; p<0.001); grade IV–V comprised 1,065 cases (17.4%). Men had higher proportions of grade IV (26.1% vs 11.1%) and grade V difficulty (4.0% vs 1.7%). Male sex remained independently associated with severe difficulty (adjusted OR 1.90 (1.59–2.28); p<0.001); AUC was 0.859 and Brier score 0.105. Conversion was rare and did not differ by sex (0.62% vs 0.42%; p=0.299). Severe difficulty stratified outcomes: operative time 105 vs 55 min, stay 8 vs 3 days, conversion 1.9% vs 0.2%, and complications 14.5% vs 5.6% (all p<0.001).
Male sex independently predicted severe intra-operative difficulty (Nassar IV–V). Incorporating sex into preoperative stratification may support list planning, senior support, and anticipatory bail-out strategy selection.
K. Khan, Samantha Ng, Ahmad H. M. Nassar· British Journal of Surgery· 0 citations
A simple end-of-case score using deprivation and two intra-operative escalation signals identifies patients at higher risk of major (CD III–V) complications after LC.
Samantha Ng, K. Khan· British Journal of Surgery· 0 citations
