ERCP's role in the management of acute biliary-pancreatic pathology in the laparoscopic era.
OBJECTIVE
Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the management of the acute biliopancreatic pathology. Nevertheless, controversy remains about the appropriate timing for retrograde cholangiopancreatography.


METHODS
A retrospective study was undertaken on a consecutive series of 117 patients with acute biliary-pancreatic pathology, who underwent laparoscopic cholecystectomy between April 1995 and April 1999. Criteria for preoperative endoscopic retrograde cholangiopancreatography were defined, and the patients were divided into 3 groups based on the presence or absence of a preoperative retrograde cholangiopancreatography indication: (1) ERCP+LC group: patients with retrograde cholangiopancreatography indicated and performed (n = 30); (2) LC group: patients without retrograde cholangiopancreatography criteria treated only by LC (n = 47); (3) LC-ERCP group: patients with retrograde cholangiopancreatography criteria but not performed (n = 40).


RESULTS
The groups were similar in age, sex, ASA, and clinical diagnosis. No statistical differences occurred in operative times (73.8 min, 68 min, 67 min), major complications (3.3%, 4.25%, 12.5%), and mean postoperative stay (3.7 +/- 4; 4.7 +/- 2; 5.7 +/- 2). Postoperative retrograde cholangiopancreatography had to be used, respectively, in 0%, 10.6%, and 7.5%. The best predictive criteria for common bile duct pathology were choledocholithiasis on an ultrasound scan and the presence of cholangitis. The other criteria tested had a low predictive value.


CONCLUSIONS
Preoperative endoscopic retrograde cholangiopancreatography followed by early laparoscopic cholecystectomy can be performed safely in acute biliary-pancreatic pathology, avoiding 2-stage treatment of these patients and minimizing hospital stay and inconvenience to the patients. Nevertheless, this therapeutic/diagnostic tool must be used selectively.
Martín del Olmo
J C
JC
Department of General and Digestive Surgery, Medina del Campo Hospital, Valladolid, Spain. jcmolmo@wanadoo.es
Toledano
M
M
Blanco
J I
JI
Cuesta
C
C
Carbajo
M
M
Vaquero
C
C
Inglada
L
L
Atienza
R
R
Martin
F
F
D000208:Acute Disease; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis*; D010195:Pancreatitis / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies