Widespread enthusiasm for laparoscopic cholecystectomy(LC) has raised new and interesting questions for the endoscopic retrograde cholangiopancraetography(ERCP) management of duct sotnes. Few laparoscopic surgeons currently explore the bile duct
at
cholecystectomy, which has focused attention on the role ERCP in the diagnosis and treatment of duct stones. We assessed the use of ERCP before and after LC at our hospital. Indications for ERCP depend on the likehood of duct pathology ;
clinical,
biochemical and radiologic predictive factors are established. Prediction of duct stones and indication for ERCP before LC were 3 groups; historic factors(recent jandice, cholangitis, pancreatitis) 25%(29/116), abnormality of liver function tests
45%
(53/116), and bile duct size(as measured at ultrasonography) 37%(43/116) in this study. ERCP is highly efficient in the management of patients with symptoms after LC in order to exclude, diagnose, and treat complications such as retained stones,
cystic
duct leaks, and strictures.
Overall, ERCP technique are sued in about 12.2% patients before and after LC of this study. The fundamental question is whether the combination(LC and endoscopic duct exploration) is a better option for the patients than "old fasioned" operative
intervention. Each surgical and endoscopic team will need to develop and test algorithms in the hope of minimizing the risk of unfortunate scenarios. (Korean J Gastroenterol 1994 ; 26 : 6541-548)
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