The Selection Criteria of Endoscopic Retrograde Cholangiography before Laparoscopic Cholecystectomy for Patients with GB Stones

Abstract

Cholecystectomy has become the standard treatment of patients with symptomatic gall-bladder stones since 19th century. Now laparoscopic cholecystectomy has become the choice of treatment for symptomatic gallbladder stones. The goal of this study was to pre-dict the role of endoscopic retrograde cholangio-pancreatography(ERCP) before laparo-scopic cholecystectomy(LC) using the liver function test(LFT) and sonography. Sixty-seven patients with symptomatic gallbladder stone, whose diagnoses were confirmed by sono-graphy, were studied by both LFT and ERCP before the operation (LC) at Ajou University Hospital from June 1994 to June 1996. Patients with either tumors or intrahepatic biliary stones by sonography were excluded. Patients were classified into groups, one with normal bile duct and the other with dilated CBD stone on sonography, and normal and abnormal LFT (including total bilirubin, alkaline phosphatase, r-glutamyl transferase and amylase) groups. Ninty seven percent of the patients with both normal biliary sonography and LFT had a negative ERCP study. Biliary tree dilation on sonography had about a seventy seven percent positive predictability for ductal pathology on ERCP (12/16). A normal biliary tree on sonography had about an eight percent incidence of positive ductal pathology on ERCP (4/51). We conclude that ERCP is not necessary before LC for patients with symptomatic gall-bladder stones who have both a normal biliary tree on sonogram and normal LFT, but a patient with a dilated bile duct on sonography does require ERCP study.