ERCP, cholangiography, and laparoscopic cholecystectomy

Summary

With the increased use of laparoscopic cholecystectomy (LC), the roles of preoperative ERCP and intraoperative cholangiography (IOC) may be changing. SAGES members were surveyed to define opinions regarding use of ERCP and cholangiography during LC. Thirty-seven percent of the surveys were returned. Most respondents (83%) performed LC, reporting data on 19,747 LCs. Conversion to open cholecystectomy was required in 4% of cases. Complications were reported in 1.7% patients. IOC was attempted in 51.2% cases and was successful in 73%. Routine IOC was only recommended by approximately 50% of respondents. However, 80% recommended IOC for patients with multiple small gallstones and a dilated cystic duct. If preoperative liver function tests (LFTs) were mildly elevated (1.5×normal), only 56% of respondents recommended preoperative ERCP. However, 73% of respondents suggested preoperative ERCP for more severe LFT abnormalities. If preoperative ERCP demonstrated choledocholithiasis, most (85%) recommended endoscopic clearance of stones followed by LC. These opinions will be helpful in establishing practice standards for LC.