IS ERCP NECESSARY FOR SYMPTOMATIC GALLBLADDER STONE PATIENTS BEFORE LAPAROSCOPIC CHOLECYSTECTOMY

Objective: Laparoscopic cholecystectomy (LC) has become the choice of treatment for symptomatic gallbladder stones. The goal of this study w as to predict the necessity for ERCP before LC using the noninvasive m ethod of liver function testing (LFT) and sonography. Methods: Before LC, 115 symptomatic gallbladder stone patients, whose diagnoses were c onfirmed by sonography, were studied by both LFT and ERCP. Patients wh o were already found to have either turners or intrahepatic biliary st ones on sonogram were excluded. Patients were classified into normal a nd dilated biliary tree groups by sonographic findings and normal and abnormal LFT (including bilirubin, alkaline phosphatase, gamma glutamy l transferase and amylase) groups. Results: In patients with both norm al biliary sonogram and LFT, 97.6% of patients had a negative ERCP stu dy. Biliary tree dilation on sonogram had an 87% positive predictabili ty for ductal pathology on ERCP (40/46). A normal biliary tree on sono gram had a 17.4% incidence of positive ductal pathology on ERCP (12/69 ). A single abnormal LFT equated to a 68.8% positive predictability fo r ductal pathology on ERCP. Conclusion: ERCP is not necessary before L C for patients with symptomatic gallbladder stones who have both a nor mal biliary tree on sonogram and normal LFT. A patient with either a d ilated bile duct on sonogram or an abnormal liver function test does r equire ERCP study.