Background and study aims: This prospective study evaluated the selective use of endoscopic retrograde cholangiography (ERC) and endoscopic ultrasonography (EUS) in the context of laparoscopic cholecystectomy (LC).
Patients and methods: Between 1993 and 1998, LC for symptomatic gallstones was indicated in 300 consecutive patients. In order to diagnose and treat choledocholithiasis preoperatively, we performed, on the basis of preoperative criteria, ERC in "high-risk" patients and EUS in "intermediate-risk" patients. Choledocholithiasis was treated by preoperative biliary endoscopic sphincterotomy (BES). LC was performed either after the endoscopic procedure or directly in "low-risk" patients.
Results: A total of 104 patients (35%) had 118 preoperative procedures: a) EUS (n = 68; feasibility 100%): choledocholithiasis was observed in 14/68 patients (21%); b) ERC (n = 50; feasibility 94%): 36 ERC were indicated on on preoperative criteria, and 14 on the basis of EUS results. Choledocholithiasis was found in 41/ 50 patients (82%) (13/14 patients with positive EUS), 19% of "intermediate-risk" patients, and 78% of "high-risk" patients; ERC failed in three patients who had no choledocholithiasis on subsequent intraoperative cholangiography (IOC). Clearance of the common bile duct (CBD) was achieved after BES in 41/41 patients. There was no mortality; complications occurred in 4/ 300 patients (1%). No retained stones were found in patients of any of the three groups, after a mean follow-up of 32 months.
Conclusions: Combined endoscopic and laparoscopie management of cholecystolithiasis and choledocholithiasis is a viable option and is optimized by the use of EUS.