Management of common bile duct stones in the era of laparoscopic cholecystectomy

Purpose To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy. Methods In patients suspected of harboring common duct stones, we performed ERCP prior to laparoscopic cholecystectomy (LC). Indications included jaundice, gallstone pancreatitis, elevated liver function tests, and visualizing a common duct stone and/or a dilated common duct on ultrasonography. Data were analyzed retrospectively. Results Of 217 patients undergoing LC, 37 (17%) had ERCP with or without endoscopic sphincterotomy (ES). Of these 37, common duct stones were noted in 19 patients (51%). Only 1 of 11 (9%) patients with mild gallstone pancreatitis had choledocholithiasis. The only complication following ERCP was pancreatitis in 1 patient who underwent uneventful LC. There were no deaths in the entire series. Conclusions ERCP and ES is a safe and effective method of clearing the common duct of stones prior to LC. Patients with mild gallstone pancreatitis do not require ERCP prior to LC