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September 1994

Gallstone PancreatitisThe Role of Preoperative Endoscopic Retrograde Cholangiopancreatography

Arch Surg. 1994;129(9):909-913. doi:10.1001/archsurg.1994.01420330023005

Objectives:  To evaluate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy in patients with gallstone pancreatitis and to determine criteria predictive of common bile duct stones (CBDS).

Design:  Retrospective chart review.

Patients:  Seventy-one consecutive patients with gallstone pancreatitis.

Main Outcome Measures:  Identification and endoscopic management of CBDS, complications, and mortality.

Results:  Preoperatively, ERCP revealed CBDS in seven of 22 patients and postoperatively, in five of six patients All stones were successfully removed. Laboratory values and common bile duct dilatation on admission did not predict CBDS. Persistent hyperamylasemia (>150 U/L) and persistent hyperbilirubinemia (>29.07 μmol/L [1.7 mg/dL]) were associated with CBDS on ERCP or intraoperative cholangiography. All five patients with cholangitis underwent ERCP, and CBDS were found and removed in four. There were no deaths and there was a 7% complication rate.

Conclusions:  Gallstone pancreatitis can be effectively managed by selective ERCP, endoscopic sphincterotomy, and laparoscopic cholecystectomy. Preoperative ERCP can be restricted to patients with cholangitis, persistent hyperbilirubinemia, or persistent hyperamylasemia.(Arch Surg. 1994;129:909-913)