The role of endoscopic retrograde cholangiopancreatography in the laparoscopic era

Background: The optimal approach to patients with suspected common bile duct (CBD) stones remains unsettled. Options include pre- and postoperative endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic exploration of the CBD. This retrospective study evaluates the role of ERCP in the management of suspected CBD stones, with an emphasis on indications, endoscopic findings, and outcome. Methods: We retrospectively reviewed the consecutive medical records of 99 patients (67 females and 32 males) who underwent ERCP for suspected CBD stones between March 1992 and December 1995. Results: In 86 patients, ERCP was performed preoperatively, Indications for ERCP included jaundice, pancreatitis, elevated liver functions tests (LFT), and ultrasound (US) or computed tomography (CT) scan findings. Forty one (48%) of 86 preoperative ERCP had positive findings; 37 (43%) were negative, and in 8 (9%) we failed to demonstrate the CBD. There were seven (8%) major complications: four cases of acute pancreatitis, one case of acute bleeding, and two cases of acute bleeding with perforation. There was no mortality. When pancreatitis was the only indication for ERCP, 0 of 8 patients had positive findings in comparison with 50% when pancreatitis was associated with jaundice and LFT, and 93% when US or CT scan demonstrated stones or dilation of the CBD. Conclusions: We conclude that ERCP is a valuable option for management of CBD stones but should be performed selectively. Neither pancreatitis alone nor LFT alone is an indication for ERCP. The presence of CBD stones is more likely when multiple indications are present.