ERCP in association with laparoscopic cholecystectomy

Abstract

Although there is an increasing tendency to clear the bile duct with a laparoscopic approach, ERCP and sphincterotomy has a certain role in conjunction with LC in the management of patients with a high suspicion of CBD stones, particularly in institutions where there is easy access to expert interventional endoscopic techniques.

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy

“…If ES is performed preoperatively, a two-stage treatment is necessary since it is followed by LC (sequential treatment) and thus accumulates the risks of the two techniques, the morbidity being of the order of 7% on average in the literature [2,5,11,12,20]. Moreover, the rate of detection of CBDS during retrograde endoscopic cholangiography is relatively low, since it varies between 50% and 60% [2, 11-13, 16, 20].…”

Management of Common Bile Duct Stones by Laparoscopic Cholecystectomy and Endoscopic Sphincterotomy: Pre-, Per- or Postoperative Sphincterotomy?

“…Treatment in two stages, which combines a preoperative ES followed by LC (sequential treatment), accumulates the morbidity of the two techniques and also has a relatively low detection rate of CBDS, in the range of 50–60%, during ERC [5, 14, 16, 19, 20]. Postoperative ES performed after LC has the advantages of maintaining minimally invasive treatment and of avoiding an unnecessary ERC.…”

Effect of Medical or Surgical Admission on Outcome of Patients with Gallstone Pancreatitis and Common Bile Duct Stones

“…[1][2][3][4][5][6][7][8][9][10][11] Others advocate endoscopicbased therapy as a means of decreasing immediate morbidity and mortality particularly in patients who are high-risk surgical candidates, who are in a center with skilled endoscopists, and in whom there is a high suspicion of CBDS. [12][13][14] Recently, a meta-analysis of 12 studies revealed that outcome-defined as successful duct clearance, mortality, overall morbidity, and need for additional procedures-was not significantly different between surgery-only and endoscopy-plus-surgery-treated groups. 15 In light of variations in treatment and, ultimately, the lack of a consensus about the "best" way to manage these disease processes, many hospitals do not have definitive triage and management pathways for patients admitted with uncomplicated GP and CBDS.…”