Selective ERCP and Preoperative Stone Removal in Bile Duct Surgery

Abstract

This project was undertaken to evaluate in a prospective fashion the effects of selective preoperative endoscopic-retrograde cholangiography and stone extraction (ERCP-ST EXTR) on the results of biliary tract surgery. Over a 6-year period, 728 patients with primary or secondary biliary tract disease were admitted to the First Surgical Department, landeskrankenanstalten, Salzburg, Austria. If, based on preoperative screening, the possibility of common bile duct stones (CBDS) existed, the patients were subjected to ERCP-ST EXTR. Two to 4 days later, these patients underwent a simple cholecystectomy with intraoperative cholangiogram and functional manometry. Evaluation criteria for this study were morbidity, mortality, and retained stone (RST) rates. The overall complication rate for the entire series was 6%. In patients who underwent operative common duct stone removal (n = 78), the complication rate amounted to 21.8%. The rate was reduced to 2.1% by ERCP-ST EXTR. The RST rate was likewise reduced from 2.2% to 0.5% by ERCP-ST EXTR. Mortality in patients with CBDS fell from 3.8% to 1% through the use of this method. In those patients with secondary stones who were treated by ERCP-ST EXTR only, morbidity was 2%, the RST rate was 0%, and mortality was 0%. It is concluded that selective ERCP-ST EXTR, followed by simple cholecystectomy, is a suitable treatment protocol and that this approach may reduce complication and mortality rates.

The role of ERCP in choledocholithiasis

“…Common duct exploration with or without cholecystectomy, however, had been associated with such high figures of 22% complication rate and 4% mortality rate [117]. ERCP and CBDS extraction reduced these complications to 2% and 1%, respectively [117].…”

“…Common duct exploration with or without cholecystectomy, however, had been associated with such high figures of 22% complication rate and 4% mortality rate [117]. ERCP and CBDS extraction reduced these complications to 2% and 1%, respectively [117]. However, others found no advantage of the combined ERCP and the conventional cholecystectomy over cholecystectomy and common duct exploration [118,119].…”

Decision-Making in Patients with Gallstones: Development of a Clinical Algorithm Using the Instrument of a Consensus Development Conference

“…By this means and including ESWL as well as local shocke-wave lithotripsy [52][53][54] the endoscopist is able to treat 90-95% of common bile duct stones with out the need of surgery [55][56][57][58]. Furthermore, it has been shown that selective preoperative endoscopic retrograde cholangiopancreatography and stone removal have very low morbidity and mortality in the laparoscopic treat ment of complicated gallstone disease [59].…”

Residual Stones in the Common Bile Duct: Critical Analysis following 2,700 Consecutive Cholecystectomies

“…The most significant changes are: (1) the use of pre-and intra-opera tive sonography; (2) the increasing use of video-cholan giography. replacing conventional film cholangiography: (3) the use of fiber-optic choledochoscopy in appropriate cases; (4) the development of endoscopic retrograde chol angiopancreatography (ERCP) and endoscopic papillot omy, and (5) percutaneous removal of stones through the T-drain tract under X-rav control (Burhenne technique) [9][10][11][12],…”