Treatment Outcomes and Complications of Three Therapeutic Approaches for Concomitant Choledocholithiasis and Cholecystolithiasis

Inclusion criteria

• Patients over the age of 18 years;
• Ultrasound, MRCP, or other imaging examination findings (CT/MRI) clearly indicate a diagnosis of cholelithiasis with concomitant choledocholithiasis;
• Patients with no history of gastrointestinal reconstruction surgery or cholecystectomy or previous biliary tract surgery (include history of ERCP);
• Patients with every gallbladder stone ≤1 cm in diameter or sludge-like stones;
• The morphology and size of the gallbladder are essentially normal and the thickness of the gallbladder wall is ≤3 mm;
• Voluntary provision of signed informed consent.

Exclusion criteria

• Atrophic cholecystitis; porcelain gallbladder; suspect malignant tumor of the gallbladder; stenosis of the lower segment of the common bile duct; Mirrizzi syndrome;
• Unable to undergo endoscopic interventions for various reasons;
• Absolute surgical contraindications, including severe hepatic, renal, cardiac and pulmonary insufficiency, history of cerebral coma and allergy to anesthesia, etc;
• Presence of ectopic duodenal papilla or congenital pancreaticobiliary malformation;
• Patients with severe coagulopathy, defined as an International Normalized Ratio (INR) > 1.5 or patients with significant thrombocytopenia (platelet count < 50 × 10⁹/L);
• Pregnant women;