TPW 7.04 Failure to Deliver Definitive Gallbladder Management after Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis: Rates, Delays, and Downstream Consequences in A Two-Hospital Scottish Health Board Cohort

Abstract

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.