Endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy: A common and potentially hazardous technique that can be avoided

Objective: To establish the extent to which preoperative endoscopic retrograde cholangiopancreatography (ERCP) is practiced by a representative group of surgeons in the United Kingdom, and to determine its safety and efficacy when compared with a policy of routine intraoperative cholangiography (RIOC), without preoperative ERCP, employed by a single surgical unit. Design: Comparison study between patients undergoing laparoscopic cholecystectomy and patients undergoing laparoscopic cholecystectomy with RIOC. Setting: Four hospitals in the Pennine Acute Hospitals NHS Trust in the northwest of England. Patients: A total of 1622 patients undergoing laparoscopic cholecystectomy during the period from 2005 to 2007. Results: Of the 1622 patients included in our analysis, 463 patients had an RIOC performed by a single surgical unit. Of the remaining 1159 patients, 188 (16.2%) underwent a preoperative ERCP for suspected common bile duct stones, 107 (56.9%) of whom had negative results. Three patients, 2 of whom had no common bile duct stones, developed post-ERCP pancreatitis. The median duration between ERCP and laparoscopic cholecystectomy was 75 days. Of the 463 patients who underwent an RIOC, 36 (7.8%) had common bile duct stones, 18 (50% of common bile duct stone cases, 3.9% of all 436 RIOC cases) of whom had no preoperative markers for common bile duct stones. There were no bile duct injuries among patients who underwent an RIOC. Conclusions: Preoperative ERCP is widely used in the United Kingdom, but it frequently results in negative findings and therefore is unnecessary. It is associated with significant morbidity, which can be avoided when a policy of RIOC is employed.