Diagnostic ERCP in the era of laparoscopic surgery

The purpose of this paper is to reassess the place and risks of ERCP in a diagnostic view.

Analysis of 196 non-operative ERCP performed in 196 patients aged 57 +/- 20 yrs. ERCP was performed for: unexplained cholestasis = 98; non tumoral pancreatic diseases = 43; suspected neoplasm of the pancreatic/biliary tract = 13; cholangitis = 12; unexplained abdominal pain = 30. Precut papillotomy was performed in 40 cases (20.4%). 10.7% were cirrhotics; 3.1% were gastrectomized. 164/196 received peri-operative broad-spectrum antibiotics.

108 had normal ERCP (group I); 74 had abnormal ERCP (group II); 12 had undetermined diagnosis after ERCP (group III). Strictly ERCP-induced mortality was nil; 2 patients died a few days after ERCP from: hemorrhage after transhepatic drainage (1); continuing severe cholangitis after failed CBD cannulation (1). Morbidity was: acute pancreatitis = 6 (3%) and fever = 4 (2%). No complication followed precut papillotomy. The 6 pancreatitis recovered within 48 h to 5 days. Fevers alleviated with antibiotics within 12 to 48 h. Pancreatitis occurred in 5/6 after normal ERCP; fevers followed pathologic ERCP in 3/4 (NS). The high rate of precuts in this series did not increase morbidity.

ERCP-related morbidity was 5.1 % and ERCP accurately diagnosed or unequivocally eliminated biliary-pancreatic disease in 92.9%. These results suggest that ERCP remains a useful and safe diagnostic tool.