Date of Award

Summer 8-15-2021

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Vanessa Bester, EdD, MPAS, PA-C


Background: Gallstone disease is common with a high prevalence in developed nations and is expected to rise as the obesity and metabolic syndrome epidemic worsens. The associated relationship between gallstone and biliary tract disease is complex. The most effective treatment approach for patients with concomitant gallstones and bile duct stones is controversial. Multiple different combinations of one-step and two-step endoscopic and/or surgical techniques exist. Advancements in laparoscopic and endoscopic methods have paved the way for a minimally invasive approach to managing cholecystocholedocholithiasis (CCL).

Methods: A literature review was conducted via systematic search of Google Scholar and PubMed to evaluate articles comparing various interventions and associated complications and outcomes between them.

Discussion: There are advantages and disadvantages amongst of each treatment strategy without a clear consensus as to which procedure is superior. Although a two-stage sequential approach is most often used in real-world clinical practice, the literature reports many favorable outcomes for a single-step procedure in terms of fewer complications, better bile duct clearance, and shorter hospital stay. Preferential treatment for a one-step protocol is also attributed to the economic pressure to limit costs and resources being used.

Conclusion: Evidence from the literature continues to support the use of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) as the mainstay treatment in patients with concurrent gallbladder and bile duct calculi. Currently, gold standard treatment is determined at the specific healthcare practice led by local professional expertise of a multidisciplinary team, endoscopist or surgeon preferences, patient risk, and available resources.


SC 11.PAS.2021.McCarney.S