Impact of the Timing of Cholecystectomy After Endoscopic Sphincterotomy on Postoperative Outcomes: A Retrospective Cohort Study

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BACKGROUND: Endoscopic sphincterotomy is the standard treatment for common bile duct stones. Early cholecystectomy is recommended after endoscopic sphincterotomy but the optimal timing remains unclear. The present study aimed to investigate the impact of the timing of cholecystectomy after endoscopic sphincterotomy on the occurrence of postoperative complications. METHODS: All patients who underwent endoscopic sphincterotomy for bile duct stone from 2009 to 2024 followed by cholecystectomy were included in the study. Patients were divided into early (≤ 72 h) and delayed (> 72 h) cholecystectomy groups. The primary outcome was severe postoperative morbidity (Clavien-Dindo grade ≥ III). Secondary outcomes included overall postoperative complications and recurrent biliary events. Multivariate logistic regression was performed to identify independent predictors. RESULTS: A total of 294 (39.5%) patients underwent early cholecystectomies and 451 (60.5%) patients underwent late cholecystectomies. Severe complications were more frequent in the delayed group (6.2% vs. 2.0%, p = 0.008), but this association was not significant after adjustment (OR = 2.16, p = 0.079). Delayed cholecystectomy was independently associated with overall postoperative complications (OR = 1.98, 95% CI [1.11-3.51], p = 0.020), as was higher ASA score (OR = 1.93, p = 0.003). Recurrent biliary events occurred mainly in the delayed group (55 vs. 3 patients). CONCLUSION: Delayed cholecystectomy beyond 72 h after ERCP is associated with increased postoperative complications and recurrent biliary events. Early cholecystectomy within 72 h should therefore be considered.

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