en Intra-Operative Endoscopic Sphincterotomy: State of the Art Basic Science Basic Science Review/Systematic Review Review/Systematic Review <sec> <div>Context</div> <p>Different approaches are routinely applied in the treatment of concomitant cholecystocholedocholithiasis. Most patients are treated by preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy in a two-stage approach. However one-stage approach carrying out intraoperative endoscopic sphincterotomy (IOES) is emerging as a minimally invasive alternative option. Our review evaluates the outcomes and potential advantages of IOES compared to the other therapeutic options.</p> </sec> <sec> <div>Evidence Acquisition</div> <p>An accurate enquiry for papers relating to IOES and the different available options was performed on different medical databases. Endpoints considered were: successful clearance of common bile duct stones, overall complication rate, procedure related morbidity, conversion rate, duration of hospital stay and costs.</p> </sec> <sec> <div>Results</div> <p>Data were collected from 21 scientific papers including: 5 prospective randomized clinical trial, 4 Meta-analysis and 12 case series. Similar rates of successful clearance of common bile duct stones were reported between Intra Operative Endoscopic Sphincterotomy (IOES) and Pre Operative Endoscopic Sphincterotomy (POES) (96.9% versus 96.3). Overall morbidity showed no statistical significant differences between the two approaches (16.1% in two stage approach versus 19.9% in one stage approach). IOES resulted superior to two-stage approach regarding duration of hospital stay with a mean difference of 2.83 days. The shorter hospital stay ensued in a reduction of cost in most studies. No differences in conversion rate were observed between POES and IOES (3.8% versus 3.7%).</p> </sec> <sec> <div>Conclusions</div> <p>Intraoperative endoscopic retrograde cholangiography is a safe, effective and feasible treatment for patients with concomitant gallbladder stones and choledocholithiasis. This review highlighted the advantages of IOES as a minimally invasive, one-stage approach. However in order to guarantee the success of such approach a profound collaboration between surgeon and endoscopist is mandatory and an efficient logistic organization of the operating theatre is needed.</p> </sec> Cholangiopancreatography, Endoscopic Retrograde,Cholecystectomy, Laparoscopic,Gallstones 100 110 http://annbsurg.iums.ac.ir/browse.php?a_code=A-10-31-129&slc_lang=en&sid=1 Fabrizio Cereatti 1003194753284600183 1003194753284600183 No Endoscopy Unit, Department of General Surgery, University of Rome &#x201C;La Sapienza&#x201D;, Rome, Italy Fausto Fiocca 1003194753284600184 1003194753284600184 No Endoscopy Unit, Department of General Surgery, University of Rome &#x201C;La Sapienza&#x201D;, Rome, Italy Gianfranco Donatelli 1003194753284600185 1003194753284600185 Yes Interventional Endoscopy Unit, Hospital Prive Poplar General Health, Paris, France