Selection criteria for pre-operative endoscopic retrograde cholangiographyand endoscopic-laparoscopic treatment of biliary stones

Objective Pre-operative endoscopic retrograde cholangiography (ERCP) prior to laparoscopic cholecystectomy (LC) is the most common treatment of gallbl adder and common bile duct (CBD) stones, In this study we evaluate our sele ction criteria for pre-operative ERCP and the results of endoscopic-laparos copic treatment in patients with CBD stones. Design Consecutive adult patients admitted to the department of surgery bec ause of symptomatic cholelithiasis were included in a prospective open tria l. Participants Between January 1996 and December 1996, 841 patients underwent LC at our hospital. ERCP pre-LC was performed in 95 of the 841 patients, o n the basis of our selection criteria. Interventions The indication to perform ERCP was suggested by a dilatated C BD (> 10 mm) or ductal stones, abnormal serum liver tests, persisting for m ore than 3 days, jaundice, cholangitis or pancreatitis. Twelve months after surgery, all patients were contacted by telephone to exclude symptoms rela ted to residual stones. Results Cannulation of the CBD was successful n 94 of 95 patients submitted to pre-LC ERCP. CBD stones were found in 87 patients (95.6%) in 22 of whom (25.2%) they were in the form of small stones or sludge. In only three of 94 patients (3.2%) no alterations of the CBD or papilla were found. Complic ations occurred in eight of 98 patients (in five after endoscopic sphincter otomy (ES), and in three after LC). Conclusions Pre-operative ES in selected patients with coexisting gallbladd er and CBD stones has been a good approach and the criteria that we used fo r selection of patients to be submitted to pre-operative ERCP/ES seem to be effective. Eur Gastroenterol Hepatol 11:781-784 (C) 1999 Lippincott Willia ms & Wilkins.