[Laparoscopic cholecystectomy: ERCP as standard preoperative diagnostic technique]

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Diagnostic Imaging

Background:

• Cholelithiasis is a common condition requiring surgical intervention.
• Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstones.
• Preoperative assessment for bile-duct stones is crucial to guide surgical management.

Purpose of the Study:

• To evaluate the diagnostic yield and clinical utility of routine preoperative endoscopic retrograde cholangiography (ERCP) in patients undergoing laparoscopic cholecystectomy (LC).
• To assess the incidence of bile duct stones and anomalies detected by ERCP in patients with and without clinical suspicion.
• To determine the complication rate associated with ERCP and endoscopic papillotomy (EPT).

Main Methods:

• A prospective study involving 250 patients with proven cholelithiasis and indications for LC.
• Patients underwent ERCP, with EPT performed if bile-duct stones were identified.
• Analysis of ERCP findings, including stone detection, anomaly identification, and complication rates.

Main Results:

• ERCP successfully visualized the biliary system in 91.6% of patients.
• Bile-duct stones were confirmed in 18 of 68 patients with clinical suspicion.
• ERCP identified stones in 8/154 patients with normal biochemical and ultrasound findings, and revealed anomalies in 7 patients.

Conclusions:

• Routine preoperative ERCP before LC should be reserved for patients with suspected bile-duct stones, considering cost-effectiveness and patient risk.
• ERCP can detect bile-duct stones and anomalies not evident on standard imaging, but small stones may be missed.
• The complication rate of ERCP/EPT was 3.2%, supporting a selective approach to preoperative biliary imaging.