Management of common bile duct stones in the era of laparoscopic cholecystectomy.

Purpose: To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy.

Methods: In patients suspected of harboring common duct stones, we performed ERCP prior to laparoscopic cholecystectomy (LC). Indications included jaundice, gallstone pancreatitis, elevated liver function tests, and visualizing a common duct stone and/or a dilated common duct on ultrasonography. Data were analyzed retrospectively.

Results: Of 217 patients undergoing LC, 37 (17%) had ERCP with or without endoscopic sphincterotomy (ES). Of these 37, common duct stones were noted in 19 patients (51%). Only 1 of 11 (9%) patients with mild gallstone pancreatitis had choledocholithiasis. The only complication following ERCP was pancreatitis in 1 patient who underwent uneventful LC. There were no deaths in the entire series.

Conclusions: ERCP and ES is a safe and effective method of clearing the common duct of stones prior to LC. Patients with mild gallstone pancreatitis do not require ERCP prior to LC.