Preoperative vs postoperative ERCP for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy: A randomized trial

The role of ERCP in choledocholithiasis

“…In spite of this careful selection, only 33% of patients were found to have CBDS [132]. Using similar predictive criteria on a patient group of mostly GS pancreatitis, Stevens found a lower sensitivity of 18% [125]. Similar to our experience, these investigators did not find any differences among their medical outcomes except for a longer length of stay for those that underwent pre-operative ERCP.…”

“…Some surgeons prefer CBD clearance prior to laparoscopic cholecystectomy while others disagree. Stevens et al reported their preliminary results on a study that randomized patients with probable choledocholithiasis or mild gallstone pancreatitis into a preoperative ERCP (group I) versus post-operative ERCP after a positive intraoperative cholangiogram (group II) [125]. There were four more days of hospitalization per patient and three times more ERCPs performed in group I, but there were no difference in morbidity between the two groups.…”

Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones

“…The majority of surgeons prefer ES to be carried out before laparoscopic cholecystectomy14, 15 because failure of endoscopic duct clearance can be resolved at surgery. However, no differences have been demonstrated in any patient‐oriented outcomes between POES and postoperative ES51, 52.…”

“…During the learning curve, failure rates of cannulation in IOES will be higher than those reported in the randomized clinical trials. Patients failing IOES could undergo postoperative ES 51,52 , or ES could be done in the prone position in the same theatre session, followed by open CBD exploration in the event of failure.…”