[Endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy in patients with suspected choledocholithiasis]. / Colangiopancreatografía retrógrada endoscópica previa a colecistectomía laparoscópica en pacientes con sospecha de coledocolitiasis.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for patients with symptomatic gallstones. The management of choledocholithiasis in these patients remains controversial. Endoscopic retrograde cholangiopancreatography (ERCP) with ductal stone clearance prior to laparoscopic cholecystectomy is one of the options. OBJECTIVE: To evaluate the results of ERCP prior to laparoscopic cholecystectomy in patients with suspected ductal stones. METHODS: We performed a retrospective study from patients who underwent ERCP prior to laparoscopic cholecystectomy in a four years period. RESULTS: ERCP was successful in 86 out of 88 patients (97.7%). Common bile duct (CBD) stones were found in 34 patients (39.5%). Sixty two of 86 patients had symptomatic gallstones with abnormal liver function test and/or ultrasound. CBD stones were found in 25 of the 62 symptomatic patients (40.3%). Twenty four patients had acute biliary pancreatitis. CBD stones were found in nine of these patients (37.5%). All patients with CBD stones underwent stone extraction after endoscopic sphincterotomy (ES). Sixteen other patients underwent ES for suspected obstruction at the ampulla. Stone extraction was successful in 100% of patients. There were six patients with complications (6.9%). Four patients had pancreatitis (4.6%), one patient hemorrhage (1.1%) and one patient cholangitis (1.1%). Analysis using logistic regression model showed that CBD stones on ultrasonography was the only variable significantly associated with choledocholithiasis (P < 0.001). CONCLUSIONS: Preoperative ERCP is useful in the management of CBD stones prior to laparoscopic cholecystectomy.