CHOLEDOCHOLITHIASIS AND GALLSTONE PANCREATITIS

Gallstones are commonly found within the main bile duct (MBD) of patie nts undergoing cholecystectomy. Retained MBD stones are a common cause of obstructive symptoms and complications. Endoscopic retrograde chol angiopancreatography (ERCP) and sphincterotomy (ES) is the recommended modality for both the detection of such stones and their extraction. Recent trials of ERCP in conjunction with laparoscopic cholecystectomy suggest that it should be reserved for use post-operatively. Gallston es within the MBD are the most common single cause of acute pancreatit is. Initial treatment is supportive, although new agents designed to s uppress the systemic inflammatory response are under development and h ave proved beneficial in clinical trials. Severe cases should be treat ed with systemic antibiotics and early removal of the obstructing ston es by ERCP and ES. Prophylactic cholecystectomy is recommended to prev ent further attacks of gallstone pancreatitis.