ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AFTER LAPAROSCOPIC CHOLECYSTECTOMY

We assessed the use of endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary re ferral center. This assessment included patients from outside institut ions with post-LC problems. Between May 1990 and September 1992, we pe rformed 522 LCs and 1,723 ERCP examinations. There were 78 patients, w ho underwent 143 ERCP examinations after LC, 65% of whom were referred . ERCP findings, were categorized as follows: normal results (8%), pro blems inherent to stone disease (65%), and iatrogenic injury (27%). Th e types of inherent problems were common bile duct (CBD) stones, pancr eatitis, and papillary stenosis/microlithiasis. Within the CBD stone g roup, 5 of 26 patients also had papillary stenosis, and, within the pa ncreatitis group, 9 of 11 patients also had papillary stenosis, making papillary stenosis the most frequent observation (55%). Almost all of these patients (96%) required endoscopic papillotomy for successful t reatment. The iatrogenic injury group was comprised of 21 patients, 16 % of whom had cystic duct leak and 84% of whom had CBD injury. These p atients required a variety of endoscopic procedures including endoscop ic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drai nage of biloma (29%), and percutaneous transhepatic biliary drainage ( 24%). Open surgical procedures after endoscopic assessment or treatmen t were required in only three patients in the iatrogenic group and in none in the inherent group. At this time, long-term follow-up is not p ossible with regard to biliary stricture. We conclude that the majorit y of problems after LC are either due to papillary stenosis/microlithi asis with or without CBD stones or to biliary injury. Both can be succ essfully diagnosed and treated with endoscopic techniques.