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Is ERCP necessary for symptomatic gallbladder stone patients before laparoscopic cholecystectomy?
C S Changchien1, S K Chuah, K W Chiu
1Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, R.O.C.
Objective:
Laparoscopic cholecystectomy (LC) has become the choice of treatment for symptomatic gallbladder stones. The goal of this study was to predict the necessity for ERCP before LC using the noninvasive method of liver function testing (LFT) and sonography.
Methods:
Before LC, 115 symptomatic gallbladder stone patients, whose diagnoses were confirmed by sonography, were studied by both LFT and ERCP. Patients who were already found to have either tumors or intrahepatic biliary stones on sonogram were excluded. Patients were classified into normal and dilated biliary tree groups by sonographic findings and normal and abnormal LFT (including bilirubin, alkaline phosphatase, gamma glutamyl transferase and amylase) groups.
Results:
In patients with both normal biliary sonogram and LFT, 97.6% of patients had a negative ERCP study. Biliary tree dilation on sonogram had an 87% positive predictability for ductal pathology on ERCP (40/46). A normal biliary tree on sonogram had a 17.4% incidence of positive ductal pathology on ERCP (12/69). A single abnormal LFT equated to a 68.8% positive predictability for ductal pathology on ERCP.
Conclusion:
ERCP is not necessary before LC for patients with symptomatic gallbladder stones who have both a normal biliary tree on sonogram and normal LFT. A patient with either a dilated bile duct on sonogram or an abnormal liver function test does require ERCP study.