Study Investigating the Best Method of Treatment of Bile Duct Stones in Higher Risk Patients

A Randomised Clinical Trial to Compare Endoscopic Sphincterotomy and Subsequent Laparoscopic Cholecystectomy With Primary Laparoscopic Bile Duct Exploration During Cholecystectomy in Higher Risk Patients With Choledocholithiasis

The aim of the trial is to compare two operations which are used to treat bile duct stones. The hypothesis of the study is that there is no difference between endoscopic sphincterotomy followed by laparoscopic cholecystectomy or laparoscopic bile duct exploration during laparoscopic cholecystectomy in the treatment of bile duct stones in higher risk patients.

Inclusion Criteria:

• Gallbladder stones
• At least strong evidence of bile duct stones (abnormal LFTs and dilated bile duct)
• Higher risk (>70yrs, >60yrs with co-morbidity, >50 with BMI>40)

Exclusion Criteria:

• Not fit for general anaesthesia
• Cholangitis requiring emergency ERCP
• Previous upper GI surgery making ERCP impossible