title: Selection criteria for pre-operative endoscopic retrograde cholangiography and endoscopic-laparoscopic treatment of biliary stones.
abstract: OBJECTIVE
  Pre-operative endoscopic retrograde cholangiography (ERCP) prior to laparoscopic cholecystectomy (LC) is the most common treatment of gallbladder and common bile duct (CBD) stones. In this study we evaluate our selection criteria for pre-operative ERCP and the results of endoscopic-laparoscopic treatment in patients with CBD stones.
  
  
  METHODS
  Consecutive adult patients admitted to the department of surgery because of symptomatic cholelithiasis were included in a prospective open trial.
  
  
  METHODS
  Between January 1996 and December 1996, 841 patients underwent LC at our hospital. ERCP pre-LC was performed in 95 of the 841 patients, on the basis of our selection criteria.
  
  
  METHODS
  The indication to perform ERCP was suggested by a dilatated CBD (> 10 mm) or ductal stones, abnormal serum liver tests, persisting for more than 3 days, jaundice, cholangitis or pancreatitis. Twelve months after surgery, all patients were contacted by telephone to exclude symptoms related to residual stones.
  
  
  RESULTS
  Cannulation of the CBD was successful in 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. Complications occurred in eight of 98 patients (in five after endoscopic sphincterotomy (ES), and in three after LC).
  
  
  CONCLUSIONS
  Pre-operative ES in selected patients with coexisting gallbladder and CBD stones has been a good approach and the criteria that we used for selection of patients to be submitted to pre-operative ERCP/ES seem to be effective.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, University of Milan, IRCCS San Raffaele Hospital Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Masci
authors.forename: L
authors.initials: L
authors.lastname: Fanti
authors.forename: A
authors.initials: A
authors.lastname: Mariani
authors.forename: S
authors.initials: S
authors.lastname: Guerini
authors.forename: W
authors.initials: W
authors.lastname: Zuliani
authors.forename: P
authors.initials: P
authors.lastname: Baccari
authors.forename: M
authors.initials: M
authors.lastname: Giacomelli
authors.forename: A
authors.initials: A
authors.lastname: Tittobello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome