The role of endoscopic retrograde cholangiopancreatography in perioperative period of laparoscopic cholecystectomy.

Objective: To explore the indications and the value of endoscopic retrograde cholangiopancreatography (ERCP) in perioperative phase of laparoscopic cholecystectomy.

Methods: From January 1998 to April 1999, a total of 1500 consecutive laparoscopic cholecystectomies were analyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkaline phosphatase level, jaundice, pancreatitis, abnormal liver function, dilated bile duct and/or stones on ultrasound or CT. The indications for postoperative group (n=20) included clinical signs or symptoms as well as common bile duct stones demonstrated by intraoperative cholangiography.

Results: Preoperative ERCP for 32 patients (2.1%) showed abnormalities in 12 (37%). Postoperative ERCP for 20 patients (1.3%) demonstrated abnormalities in 14 (70%). Super-selected criteria for preoperative ERCP would predict more than 66% ductal stones. Endoscopic sphincterectomy and duct stones clearance were performed in all 16 patients with documented common bile duct stones. The morbidity was confined in 2 patients with self-limited pancreatitis (3%).

Conclusions: Using super-selected criteria to select patients for preoperative ERCP can avoid unnecessary ERCP. As soon as postoperative patients have clinical signs or symptoms, endoscopic treatment should be performed.