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The Role of Preoperative Endoscopic Retrograde Cholangiopancreatography

Christian de Virgilio, MD; Christopher Verbin, MD; Lin Chang, MD; Stuart Linder, MD; Bruce E. Stabile, MD; Stanley Klein, MD

Arch Surg. 1994;129(9):909-913.

Abstract
Objectives
To evaluate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy in patients with gallstone pancreatitis and to determine criteria predictive of common bile duct stones (CBDS).

Design
Retrospective chart review.

Patients
Seventy-one consecutive patients with gallstone pancreatitis.

Main Outcome Measures
Identification and endoscopic management of CBDS, complications, and mortality.

Results
Preoperatively, ERCP revealed CBDS in seven of 22 patients and postoperatively, in five of six patients All stones were successfully removed. Laboratory values and common bile duct dilatation on admission did not predict CBDS. Persistent hyperamylasemia (>150 U/L) and persistent hyperbilirubinemia (>29.07 µmol/L [1.7 mg/dL]) were associated with CBDS on ERCP or intraoperative cholangiography. All five patients with cholangitis underwent ERCP, and CBDS were found and removed in four. There were no deaths and there was a 7% complication rate.

Conclusions
Gallstone pancreatitis can be effectively managed by selective ERCP, endoscopic sphincterotomy, and laparoscopic cholecystectomy. Preoperative ERCP can be restricted to patients with cholangitis, persistent hyperbilirubinemia, or persistent hyperamylasemia.

(Arch Surg. 1994;129:909-913)

Author Affiliations
From the Departments of Surgery and Gastroenterology, Harbor-University of California—Los Angeles Medical Center, Torrance, Calif.

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