Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy

Tham, T. C. K.; Lichtenstein, David R.; Vandervoort, Jo; Wong, R.C.K.; Brooks, David; Dam, Jacques Van; Ruymann, F.; Farraye, Francis A.; Carr‐Locke, D. L.

doi:10.1016/s0016-5107(98)70298-6

Cited by 87 publications

(49 citation statements)

References 18 publications

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“…This is supported by the results of other studies [9, 10]. Thus there is a need to refine the selection criteria for preoperative ERCP to avoid unnecessary investigations and to reduce risk and costs.…”

Section: Discussionsupporting

confidence: 57%

Must ERCP Be Routinely Performed if Choledocholithiasis Is Suspected?

Hoyuela¹,

Cugat²,

Bretcha³

et al. 1999

Dig Surg

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Objective: To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). Patients and Methods: A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. Results: ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. Conclusions: A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.

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Section: Discussionsupporting

confidence: 57%

Must ERCP Be Routinely Performed if Choledocholithiasis Is Suspected?

Hoyuela¹,

Cugat²,

Bretcha³

et al. 1999

Dig Surg

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“…However, on the basis of previous reports [11,17,20] that recommend preoperative ERC only in patients with a high risk of CBDS, we can get some conclusions. First, practically speaking, cholelithiasis patients younger than 71 years who have abdominal USG findings suggestive of CBDS and patients older than age 70 years who have elevated direct bilirubin should undergo preoperative ERC examination.…”

Section: Discussionmentioning

confidence: 97%

Practical recommendations for the prediction and management of common bile duct stones in patients with gallstones

Atlı

Doğanay

et al. 2001

Surg Endosc

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“…For example, in a retrospective study including 1097 consecutive patients who underwent laparoscopic cholecystectomy, Tham and colleagues found that limiting preoperative ERCP to patients with an elevated bilirubin level (> 34 µmol/L) or evidence of stones on ultrasonography or computed tomography (CT) would have decreased the number of unnecessary ERCPs by 50%. 18 Stratification of the probability of common bile duct stones was used in a prospective study involving 440 patients undergoing laparoscopic cholecystectomy. It was used to select the approach to imaging and management: ERCP if the probability is extremely high, magnetic resonance cholangiopancreatography if it is high, laparoscopic cholecystectomy with intraoperative cholangiography if it is intermediate, and laparoscopic cholecystectomy without intraoperative cholangiography if the probability is low.…”

Section: What Is the Optimal Approach To Management?mentioning

confidence: 99%