The role of endoscopic retrograde cholangiopancreatography in perioperative period of laparoscopic cholecystectomy.
OBJECTIVE
To explore the indications and the value of endoscopic retrograde cholangiopancreatography (ERCP) in perioperative phase of laparoscopic cholecystectomy.


METHODS
From January 1998 to April 1999, a total of 1500 consecutive laparoscopic cholecystectomies were analyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkaline phosphatase level, jaundice, pancreatitis, abnormal liver function, dilated bile duct and/or stones on ultrasound or CT. The indications for postoperative group (n=20) included clinical signs or symptoms as well as common bile duct stones demonstrated by intraoperative cholangiography.


RESULTS
Preoperative ERCP for 32 patients (2.1%) showed abnormalities in 12 (37%). Postoperative ERCP for 20 patients (1.3%) demonstrated abnormalities in 14 (70%). Super-selected criteria for preoperative ERCP would predict more than 66% ductal stones. Endoscopic sphincterectomy and duct stones clearance were performed in all 16 patients with documented common bile duct stones. The morbidity was confined in 2 patients with self-limited pancreatitis (3%).


CONCLUSIONS
Using super-selected criteria to select patients for preoperative ERCP can avoid unnecessary ERCP. As soon as postoperative patients have clinical signs or symptoms, endoscopic treatment should be performed.
Wu
Wei-Ze
WZ
Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China. wuweize@hotmail.com
Zheng
Ming-Hua
MH
Wang
Jian-Cheng
JC
Chen
Sheng
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care