ERCP Timing in Gallstone Disease: A Meta-Analysis of One-Stage versus Two-Stage Strategies

Abstract

Background: Cholecystocholedocholithiasis involves gallbladder and bile duct stones. Standard two-stage care involves ERCP followed by cholecystectomy, whereas single-stage intraoperative ERCP may streamline treatment. We performed a meta-analysis comparing stone clearance, complications, and hospital stay between single-stage and two-stage strategies. Method: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2025 for clinical studies comparing one-stage laparo-endoscopic rendezvous with two-stage ERCP + LC. RCTs and observational studies reporting stone clearance, complications, conversion, bile leaks, hospital stay, repeat ERCP, or cannulation failure were included. Data extraction and ROB2/NOS assessments were done independently. Result: Twenty-four studies met the inclusion criteria. The one-stage approach demonstrated significantly higher CBD clearance (96.5% vs. 91.8%; RR = 1.03) and a notably lower overall complication rate (11.55% vs. 19.56%; RR = 0.51). Postoperative pancreatitis (RR = 0.50), cholangitis (RR = 0.33), and bleeding (RR = 0.47) were also significantly reduced. Although conversion to open surgery and bile leak rates were lower in the one-stage group, these differences were not statistically significant. Importantly, single-stage management resulted in shorter hospital stays (mean difference = −3.23 days), fewer postoperative repeat ERCPs (RR = 0.21), and markedly reduced cannulation failure (RR = 0.26). Conclusion: The one-stage approach for managing bile duct stones offers higher clearance rates, fewer complications, and shorter hospital stays compared to the two-stage approach. These results support adopting one-stage treatment as a more effective and efficient clinical strategy.