Follow-up of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: A prospective study of 300 patients

Background and Study Aims: This prospective study evaluated the selective u se of endoscopic retrograde cholangiography (ERC) and endoscopic ultrasonog raphy (EUS) in the context of laparoscopic cholecystectomy (LC), Patients and Methods: Between 1993 and 1998, LC for symptomatic gallstones was indicated in 300 consecutive patients. In order to diagnose and treat c holedocholithiasis preoperatively, we performed, on the basis of preoperati ve criteria, ERC in "high-risk" patients and EUS in "intermediate-risk" pat ients. Choledocholithiasis was treated by preoperative biliary endoscopic s phincterotomy (BES), LC was performed either after the endoscopic procedure or directly in "low-risk" patients, Results: A total of 104 patients (35%) had 118 preoperative procedures: a) EUS (n=68; feasibility 100%): choledocholithiasis was observed in 14/68 pat ients (21%); b) ERC (n = 50; feasibility 94%): 36 ERC were indicated on on preoperative criteria, and 14 on the basis of EUS results, Choledocholithia sis was found in 41/50 patients (82%) (13/14 patients with positive EUS), 1 9% of "intermediate-risk" patients, and 78% of "high-risk" patients; ERC fa iled in three patients who had no choledocholithiasis on subsequent intraop erative cholangiography (IOC), Clearance of the common bile duct (CBD) was achieved after BES in 41/41 patients. There was no mortality; complications occurred in 4/300 patients (1%), No retained stones were found in patients of any of the three groups, after a mean follow-up of 32 months. Conclusions: Combined endoscopic and laparoscopie management of cholecystol ithiasis and choledocholithiasis is a viable option and is optimized by the use of EUS.