A randomized controlled trial of emergency LCBDE + LC and ERCP + LC in the treatment of choledocholithiasis with acute cholangitis

Introduction
Emergency biliary drainage is the basic treatment for acute cholangitis caused by choledocholithiasis.

Aim
To compare the effectiveness and safety of emergency laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy (LCBDE + LC) and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy (ERCP + LC) for the treatment of choledocholithiasis combined with grade I or II acute cholangitis.

Material and methods
A total of 80 patients were enrolled in the study, with 40 cases in each group. A prospective randomized controlled study method was adopted, and the eligible patients were randomly divided into two groups in a ratio of 1 : 1 and treated with emergency LCBDE + LC and ERCP + LC, respectively. The relevant clinical data of the two groups were compared.

Results
The operation duration was longer and blood loss was greater in the LCBDE + LC group than in the ERCP + LC group, but the therapeutic cost was significantly lower in the former than in the latter. The differences were statistically significant (p < 0.05 in all). There was no severe complication in either group. The total number of cases with complications, incidence of postoperative acute pancreatitis and incidence of hemorrhage were higher in the ERCP + LC group than in the LCBDE + LC group, while the incidence of bile leakage was lower in the former than in the latter. The differences were statistically significant (p < 0.05 in all).

Conclusions
Both protocols were safe and feasible in the management of grade I or II acute calculous cholangitis. Compared with the protocol of ERCP + LC, the protocol of LCBDE + LC had the advantages of fewer complications and lower therapeutic costs and is worthy of clinical promotion.