Comparison of radiation exposure and fluoroscopy time between minimally invasive common bile duct exploration and endoscopic retrograde cholangiopancreatography for choledocholithiasis

Background: Radiation exposure (RE) causes dose-dependent deleterious effects, and efforts should be made to decrease patient exposure to ionizing radiation. Patients with choledocholithiasis are commonly exposed to ionizing radiation as fluoroscopy-guided interventions including minimally invasive common bile duct (CBD) exploration (MICBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred treatment modalities for CBD stone clearance. However, RE and fluoroscopy times (FTs) have not been compared between these 2 treatment modalities. Thus, this study aimed to compare FT and RE between MICBDE and ERCP in patients with choledocholithiasis.

Methods: This is a retrospective analysis of a prospectively maintained database of a single surgeon performing MICBDE at an academic referral center between May 2021 and June 2023 compared with a retrospective analysis of all ERCPs performed between January 2020 and February 2021. Patient demographics, procedural details, fluoroscopic details, and postoperative outcomes were compared between the MICBDE and ERCP. The study was conducted as a single institution academic referral center located in the American Southwest. A total of 109 patients with choledocholithiasis were divided into 2 groups. A total of 53 (48.62%) patients underwent ERCP, and 56 (51.38%) patients underwent MICBDE. Inclusion criterion was all patients presenting with choledocholithiasis and subsequently undergoing ERCP or MICBDE. Patients who underwent ERCP for non-choledocholithiasis-related reasons were excluded. Primary outcomes include FT measured in minutes and RE measured in milligray (mGy). Secondary outcomes were successful clearance of the CBD, complications, procedural time, and reinterventions.

Results: A significant difference (P < .001) between FTs was identified between ERCP (3.1 min) and MICBDE (1.54 min). Median RE doses between the ERCP group (38 mGy) and the MICBDE group (38.41 mGy) were not statistically different (P = .88). Technical success of CBD clearance was similar in both groups (91% in the MICBDE group vs 93% in ERCP group; P = .711).

Conclusion: Advantages of MICBDE over ERCP include the treatment of choledocholithiasis at the time of cholecystectomy, which reduces the risk of additional anesthesia episodes and introduces the potential for shorter hospital length of stay. This study showed that MICDBE had lower FT than had ERCP, and comparable RE. Given the advantages of MICBDE, it should be strongly considered at the time of laparoscopic cholecystectomy.