Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions_West China Medical Journal

Authors：

 TAOLi-ping , LIXiao , CHENLin , WUChun-cheng , HUBing ,  WANGChun-hui

Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANGChun-hui, Email: chwangsc@yahoo.com

Keywords：

Common bile duct stone; Endoscopic retrograde cholangio-pancreatography; Laparoscopy; Laparotomy; Cost-effectiveness

DOI：

10.7507/1002-0179.20140555

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Objective To compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. Methods A total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). Results For simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. Conclusion For patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.

Citation： TAOLi-ping, LIXiao, CHENLin, WUChun-cheng, HUBing, WANGChun-hui. Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions. West China Medical Journal, 2014, 29(10): 1823-1826. doi: 10.7507/1002-0179.20140555 Copy

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2.	Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ[J]. B J Surg, 2006(93):1185-1191.
3.	Yoshida K1, Yamazaki Y, Mizuno R, et al. Laparoscopic splenectomy in children. Preliminary results and comparison with the open technique[J]. Surg Endosc, 1995, 9(12):1279-1282.
4.	Sgourakis G, Lanitis S, Karaliotas CH, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A retrospective case-control study[J]. Chirurg, 2012, 83(10):897-903.
5.	李俊达, 何剑琴. 内镜治疗胆总管结石与传统手术的疗效分析[J]. 中国内镜杂志, 2007, 13(7):705-707.
6.	苏秉忠, 陈平, 宋建忠, 等. 胆总管结石内镜和手术治疗效果的对照分析[J]. 现代消化及介入诊疗, 2007, 12(4):228-231.
7.	许卓明, 苏树英, 甄作均, 等. 腹腔镜胆总管切开术与内镜括约肌切开术治疗胆总管结石的比较[J]. 中华普通外科杂志, 2007, 22(6):410-412.
8.	Lu J, Cheng Y, Xiong XZ, et al. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol, 2012, 18(24):3156-3166.
9.	Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial[J]. Surg Endosc, 2014, 28(3):875-885.
10.	Alexakis N, Connor S. Meta-analysis of one-vs two-stage laparoscopic/endoscopic management of common bile duct stones[J]. HPB (Oxford), 2012, 14(4):254-259.
11.	Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013, 9:CD003327.
12.	Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session:feasibility and safety[J]. World J Gastroenterol, 2013, 19(36):6093-3097.
13.	Jones M, Johnson M, Samourjian E, et al. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure:a random comparison to the standard (two-step) procedure[J]. Surg Endosc, 2013, 27(6):1907-1912.

1. 张振中, 孙源源, 昭建国, 等. 十二指肠镜治疗胆总管结石与腹腔镜和外科手术的成本-效果分析[J]. 中国医师进修杂志, 2011, 34(8):55-57.
2. Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ[J]. B J Surg, 2006(93):1185-1191.
3. Yoshida K1, Yamazaki Y, Mizuno R, et al. Laparoscopic splenectomy in children. Preliminary results and comparison with the open technique[J]. Surg Endosc, 1995, 9(12):1279-1282.
4. Sgourakis G, Lanitis S, Karaliotas CH, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A retrospective case-control study[J]. Chirurg, 2012, 83(10):897-903.
5. 李俊达, 何剑琴. 内镜治疗胆总管结石与传统手术的疗效分析[J]. 中国内镜杂志, 2007, 13(7):705-707.
6. 苏秉忠, 陈平, 宋建忠, 等. 胆总管结石内镜和手术治疗效果的对照分析[J]. 现代消化及介入诊疗, 2007, 12(4):228-231.
7. 许卓明, 苏树英, 甄作均, 等. 腹腔镜胆总管切开术与内镜括约肌切开术治疗胆总管结石的比较[J]. 中华普通外科杂志, 2007, 22(6):410-412.
8. Lu J, Cheng Y, Xiong XZ, et al. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol, 2012, 18(24):3156-3166.
9. Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial[J]. Surg Endosc, 2014, 28(3):875-885.
10. Alexakis N, Connor S. Meta-analysis of one-vs two-stage laparoscopic/endoscopic management of common bile duct stones[J]. HPB (Oxford), 2012, 14(4):254-259.
11. Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013, 9:CD003327.
12. Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session:feasibility and safety[J]. World J Gastroenterol, 2013, 19(36):6093-3097.
13. Jones M, Johnson M, Samourjian E, et al. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure:a random comparison to the standard (two-step) procedure[J]. Surg Endosc, 2013, 27(6):1907-1912.

West China Medical Journal

Cost-effectiveness Analysis of Endoscopic Retrograde Cholangio-pancreatography and Surgery in the Treatment of Common Bile Duct Stone or Combined with Gallbladder Benign Lesions

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