ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY BEFORE AND AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background: While the role of endoscopic retrograde cholangiopancreato graphy (ERCP) and endoscopic sphincterotomy (EST) in the diagnosis and management of choledocholithiasis is well established, this study eva luates the usefulness of ERCP and EST in patients with symptomatic cho lecystolithiasis and suspected choledocholithiasis before undergoing l aparoscopic cholecystectomy (LC), and the role of ERCP-EST in the mana gement of complications resulting from LC. Materials and Methods: This paper reviews retrospectively our experience from 1992 to 1995. A tot al of 1221 LCs and 717 ERCPs were performed, out of which 257 ERCPs we re performed on 225 patients who underwent LC (230 ERCPs before and 27 after). The age range was 10-85 years (mean 43.5). The study group co mprised 148 females (66%) and 77 males (34%). Results: The overall suc cess rate for ERCP was 92% (96% for diagnostic and 88% for therapeutic ). Choledocholithiasis was found at preoperative ERCP in 45% of cases. Prediction of choledocholithiasis was accurate in 46%, based on abnor mal liver chemistry, and 70% when based on a combination of abnormal l iver tests and dilated main bile duct (>7 mm) by ultrasound. In 40 cas es of acute biliary pancreatitis, choledocholithiasis was found at ERC P in eight cases (20%). In the post-LC group, all eight cases with res idual stones and seven of eight cases with bile leaks were successfull y treated endoscopically. There were four cases with major duct injuri es that required surgical management. The complications related to ERC P-EST included two cases of bleeding post-EST (one was controlled with injection therapy and the second one was managed surgically), and thr ee cases of mild pancreatitis. Conclusion: ERCP and EST are effective and safe in the diagnosis and management of choledocholithiasis, and f acilitate LC for symptomatic cholelithiasis. The procedures are also v aluable in the diagnosis and management of most complications resultin g from LC.