Preoperative ERCP in the Management of Common Bile Duct Stones before Laparoscopic Cholecystectomy

Abstract

Objective: To evaluate the effectiveness of a policy of preoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) before laparoscopic cholecystectomy. Design: Retrospective review. Setting: University hospital, Singapore. Subjects: From January 1991 to December 1992, 303 patients underwent elective laparoscopic cholecystectomy, of which 46 (15%) were selected to have ERCP preoperatively because they had clinical, biochemical, and ultrasound signs of the presence of stones in the common bile duct (CBD). Main outcome measures: Effectiveness and efficiency of ERCP. Results: Successful cannulation of the CBD was achieved in 45/46 cases (98%). In 19 patients (42%) stones were found, of which 18 (95%) were removed endoscopically. There were no major complications from the ERCP or the sphincterotomy. One patient developed symptoms from an unsuspected common duct stone two weeks after cholecystectomy and it was removed endoscopically. Conclusion: Selective preoperative ERCP is an effective and safe way of clearing the CBD before laparoscopic cholecystectomy, but its efficiency can be improved further by widening the criteria for preoperative ERCP and by doing operative cholangiography for patients with a low risk of stones in the CBD.