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 onestage 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. results: 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 twostage 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%). conclusions: 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, onestage 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.