185 Meta Analysis of Laparoendoscopic Rendezvous (LERV) Versus Two-Stage ERCP and Laparoscopic Cholecystectomy for Cholecystocholedocholithiasis

Abstract Aim Laparoendoscopic rendezvous (LERV) and the two-stage approach of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) are commonly used for managing patients with both gallstones and common bile duct (CBD) stones. This systematic review and meta-analysis compares the safety and efficacy of LERV versus the conventional two-stage ERCP plus LC strategy. Method A systematic search of the literature was conducted, covering studies from January 1990 to December 2024. Randomized controlled trials (RCTs) and observational studies comparing LERV with two-stage ERCP followed by LC were included. Primary outcomes assessed were overall morbidity and complete CBD clearance. Secondary outcomes included procedure duration and incidence of post-ERCP pancreatitis. Statistical analysis was performed using the Cochrane RevMan software. A random-effects model was applied, and forest plots were generated to visualise combined results. Results Ten studies including a total of 1687 patients (880 underwent LERV; 807 underwent ERCP + LC) met inclusion criteria. LERV was significantly associated with lower overall morbidity (RR = 0.48; 95% CI: 0.35–0.66), shorter hospital stay (MD: -1.15, CI -1.63 – -0.67, p < 0.001), and a lower rate of post-ERCP pancreatitis (RR = 0.38; 95% CI: 0.24–0.61). Stone clearance was similar between groups (RR = 1.03, CI 0.99–1.07, p = 0.10). ERCP + LC had a shorter procedure time (MD: 1.19, CI 0.61–1.76, p < 0.0001). Conclusions LERV is a safe and effective alternative to two-stage ERCP followed by LC, offering reduced complication rates and shorter hospitalisation without compromising stone clearance. These findings support broader adoption of LERV in appropriate clinical settings.