Endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis

Adrian Park, M. J. Mastrangelo

Research output: Contribution to journalReview article

Abstract

Surgeons today have a wide range of therapeutic options for the management of patients with choledocholithiasis. Endoscopists, interventional radiologists, and surgeons employ a variety of techniques to access and remove common bile duct stones (CBDS) successfully. Although earlier studies have been done to assess the relative merits of laparoscopic and endoscopic management of CBDS, few of them have employed a randomized prospective trial for the comparison. Without recognized parameters for comparison, no definitive conclusions can be drawn. Herein, we examine the role of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as an important adjunct to laparoscopic cholecystectomy (LC) in the management of CBDS. The three main scenarios in which this modality is employed for CBDS removal are selective preoperative ERCP, intraoperative ERCP, and postoperative ERCP. We conclude that an appropriate balance must be struck to maintain a high yield of positive or therapeutic ERCP, avoid unnecessary ERCP, and not miss CBDS, while ensuring acceptably low rates of morbidity and mortality and controlling costs. As we await the publication of prospective data, we may look for direction from decision analysis in order to develop optimal management strategies and define the 'best practice' results that should be expected of operators before new procedures and innovative technology are accepted on a widespread basis.

Original languageEnglish (US)
Pages (from-to)219-226
Number of pages8
JournalSurgical Endoscopy
Volume14
Issue number3
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Choledocholithiasis
Endoscopic Retrograde Cholangiopancreatography
Common Bile Duct
Decision Support Techniques
Laparoscopic Cholecystectomy
Practice Guidelines
Publications
Therapeutics
Technology
Morbidity
Costs and Cost Analysis
Mortality

Keywords

  • Choledocholithias
  • Common bile duct stones
  • Endoscopic retrograde cholangiopancreatography
  • ERCP
  • Gallbladder
  • Laparoscopic common bile duct exploration

ASJC Scopus subject areas

  • Surgery

Cite this

Endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis. / Park, Adrian; Mastrangelo, M. J.

In: Surgical Endoscopy, Vol. 14, No. 3, 01.01.2000, p. 219-226.

Research output: Contribution to journalReview article

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