PREOPERATIVE ERCP IN THE MANAGEMENT OF COMMON BILE-DUCT STONES BEFORELAPAROSCOPIC CHOLECYSTECTOMY

Objective: To evaluate the effectiveness of a policy of preoperative e ndoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sp hincterotomy (ES) before laparoscopic cholecystectomy. Design: Retrosp ective review. Setting: University hospital, Singapore. Subjects: From January 1991 to December 1992, 303 patients underwent elective laparo scopic cholecystectomy, of which 46 (15%) were selected to have ERCP p reoperatively because they had clinical, biochemical, and ultrasound s igns of the presence of stones in the common bile duct (CBD). Main out come measures: Effectiveness and efficiency of ERCP. Results: Successf ul cannulation of the CBD was achieved in 45/46 cases (98%). In 19 pat ients (42%) stones were found, of which 18 (95%) were removed endoscop ically. There were no major complications from the ERCP or the sphinct erotomy. One patient developed symptoms from an unsuspected common duc t stone two weeks after cholecystectomy and it was removed endoscopica lly. Conclusion: Selective preoperative ERCP is an effective and safe way of clearing the CBD before laparoscopic cholecystectomy, but its e fficiency can be improved further by widening the criteria for preoper ative ERCP and by doing operative cholangiography for patients with a low risk of stones in the CBD.