The Role of Endoscopic Retrograde Cholangiopancreatography in the Era of Laparoscopic Cholecystectomy.
The technique of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES), for removal of bile duct (BD) stones have been highly successful (>90%). The preoperative indications include cholangitis, worsening gallstone pancreatitis, patients with jaundice, and in those patients who have common bile duct stones seen on ultrasonography. Intraoperatively ERCP/ES has been used along with the placement of a papillotome through the cystic duct and papilla and performing a sphincterotomy in an antegrade fashion. The approach with the least complications is with the antegrade passage of the papillotome, and both techniques are efficient and safe in removal of proximal and distal BD stones. The postoperative indications for ERCP include retained common bile duct stones, bile duct injury, bile leak, and in patients who have developed a bile duct stricture. A success rate of 90% to 95% for complete removal of bile duct stones has been achieved. Overall, ERCP/ES is a highly effective procedure for removing bile duct stones, but it should be used only in selected patients preoperatively, intraoperatively, and postoperatively.
Department of Surgery, University of Texas Health Science Center, Houston, TX, USA
BV
MacFadyen
RB
Passi