Lauri A, Cocomello L, Fabiani S, Lauri G, Rando G. Gallstones and common bile duct stones management: Single-stage vs two-stage treatment. World J Gastrointest Endosc 2025; 17(10): 107984 [DOI: 10.4253/wjge.v17.i10.107984]
Corresponding Author of This Article
Gaetano Lauri, MD, Consultant, Department of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Lombardy, Italy. gaetanolauri.94@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 16, 2025 (publication date) through Oct 19, 2025
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Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lauri A, Cocomello L, Fabiani S, Lauri G, Rando G. Gallstones and common bile duct stones management: Single-stage vs two-stage treatment. World J Gastrointest Endosc 2025; 17(10): 107984 [DOI: 10.4253/wjge.v17.i10.107984]
Adriano Lauri, Lucia Cocomello, Stefano Fabiani, Giacomo Rando, Department of Gastroenterology and Endoscopy, Ospedale Civile Santo Spirito, Pescara 65124, Abruzzo, Italy
Gaetano Lauri, Department of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan 20132, Lombardy, Italy
Co-first authors: Adriano Lauri and Lucia Cocomello.
Author contributions: Lauri A designed the study outline and coordinated the preparation and revision of the manuscript; Cocomello L performed the majority of the writing and literature analysis; Fabiani S and Rando G provided critical revisions, conceptual input, and prepared the figures and tables; Lauri G contributed to data collection and drafting of the manuscript. Lauri A and Cocomello L contributed equally to this manuscript and are co-first authors. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gaetano Lauri, MD, Consultant, Department of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Lombardy, Italy. gaetanolauri.94@gmail.com
Received: April 2, 2025 Revised: June 9, 2025 Accepted: September 19, 2025 Published online: October 16, 2025 Processing time: 197 Days and 10.8 Hours
Abstract
BACKGROUND
The optimal management of gallstones and common bile duct stones remains a subject of ongoing debate. The conventional two-stage treatment involves initial endoscopic retrograde cholangiopancreatography (ERCP) to clear the bile duct, followed by laparoscopic cholecystectomy. Alternatively, the single-stage laparoendoscopic rendezvous (LERV) procedure combines ERCP and laparoscopic cholecystectomy in the same surgical session.
AIM
To evaluate the efficacy, safety, and logistical considerations of these two approaches, emphasizing their implications for different healthcare settings.
METHODS
A literature search was conducted through a PubMed search (2010-2024) using the terms “laparoendoscopic rendezvous”, “endoscopic retrograde cholangiopancreatography”, and “cholecystocholedocholithiasis”. Only English-language studies were included.
RESULTS
In our analysis, LERV significantly reduced the incidence of post-ERCP pancreatitis by 67% (2.4% vs 8.8%) and shortened hospital stay by a mean of up to 6 days. Stone clearance rates were comparable between LERV (97%) and the two-stage approach (96%). Although LERV was associated with a longer operative time (139.8 minutes vs 107.7 minutes), it demonstrated lower overall costs, largely due to reduced hospitalization. Rates of postoperative bleeding, cholangitis, and bile leak were low and did not differ significantly between groups.
CONCLUSION
The single-stage LERV approach is safe, effective, and associated with lower pancreatitis rates, shorter hospital stays, and reduced costs compared to the two-stage strategy. Its implementation, however, requires coordinated surgical-endoscopic expertise, making it most suitable for well-equipped centers and carefully selected patients.
Core Tip: The conventional two-stage approach separates endoscopic and surgical interventions, whereas the single-stage laparoendoscopic rendezvous procedure provides a more streamlined alternative. This study highlights the advantages of laparoendoscopic rendezvous, including shorter hospital stay, a reduced risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, and improved bile duct clearance. Furthermore, we examine its feasibility across various healthcare settings, particularly in low-volume centers, where procedural consolidation could enhance outcomes. Future studies should focus on refining patient selection and evaluating long-term benefits to optimize clinical practice.
