Timing of cholecystectomy after ERCP for common bile duct stones (Dutch Timeliness study)

Background

Gallstone disease is frequently encountered in the Netherlands and may lead to a variety of complications. One of these complications is obstruction of the common bile duct, known as choledocholithiasis. The treatment consists of bile duct clearance and cholecystectomy. In the Netherlands, bile duct clearance is obtained by an Gastro-enterologist with endoscopic retrograde cholangiopancreatography (ERCP). Next, a laparoscopic cholecystectomy is performed by a surgeon To prevent recurrent problems in the waiting time between cholecystectomy and ERCP, the cholecystectomy has to be performed within 72 hours. Whilst guidelines are clear; implementation is lagging behind. Considering that choledocholithiasis is treated in various hospital types and sizes,  treatment strategy following common bile duct clearance is influenced by logistics, medical reasons and personal preference. The present study aims to improve guideline implementation in the Netherlands by providing performance feedback. Due to the high incidence of choledocholithiasis, this study will have a large clinical impact.

Objective

To determine the current proportion of patients undergoing early cholecystectomy following successful ERCP for choledocholithiasis in the Netherlands (current guide-line adherence). Secondary objectives:

1. To identify factors influencing the percentage of patients receiving early cholecystectomy
2. To assess the relationship between the interval duration from choledocholithiasis diagnosis to ERCP and the recurrence of intermittent biliary complications and total length of hospital stay
3. To assess the relationship between the interval duration from ERCP to cholecystectomy and the recurrence of intermittent biliary complications and total length of hospital stay.

Study design

Snapshot of a 3 month period in the Netherlands, 1-1-2023 to 31-3-2023. Retrospective data collection of all patients undergoing successful ERCP for choledocholithiasis.

• Patient characteristics
• Hospital characteristics
• ERCP characteristics
• Time to cholecystectomy
• Cholecystectomy characteristics
• Hospital stay (during primary admission and subsequent re-admissions
• Complications and reinterventions

Study population

All patients undergoing successful ERCP for choledocholithias between 1-1-2023 to 31-3-2023.

Main expected results

This snapshot will provide each hospital insight into their own performance regarding adherence to the national guideline. Furthermore, barriers and opportunities for improving adherence to the national guideline will be revealed.

Planning

The Dutch TIMELINESS study is currently (start 2026) in phase 3 of 3.
Phase 1, consisting of retrospective data collection as a baseline measurement, has been completed. This database includes approximately 1,500 patients.
Phase 2, the implementation phase, has been finalized in most participating hospitals.
Phase 3 is currently ongoing, with prospective patient inclusion to evaluate the impact of the implemented changes. 

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