Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2015; 21(2): 609-615
Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.609
Intraoperative endoscopic retrograde cholangio-pancreatography: A useful tool in the hands of the hepatobiliary surgeon
Ayman El Nakeeb, Ahmad M Sultan, Emad Hamdy, Ehab El Hanafy, Ehab Atef, Tarek Salah, Ahmed A El Geidie, Tharwat Kandil, Mohamed El Shobari, Gamal El Ebidy
Ayman El Nakeeb, Ahmad M Sultan, Emad Hamdy, Ehab El Hanafy, Ehab Atef, Tarek Salah, Tharwat Kandil, Mohamed El Shobari, Gamal El Ebidy, Ahmed A ElGeidie, Gastroenterology surgical center, Mansoura University, Daqahlia 35516, Egypt
Author contributions: El Nakeeb A and El Shobari M designed the research; El Nakeeb A, Sultan AM, Hamdy E, El Hanafy E, Atef E, Salah T, El Geidie AA, Kandil T, El Shobari M and El Ebidy G performed the research; El Nakeeb A, El Shobari M analyzed the data; El Nakeeb A and Sultan AM wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman El Nakeeb, Associate Professor of General Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Daqahlia 35516, Egypt. elnakeebayman@yahoo.com
Telephone: +20-10-6752021 Fax: +20-50-2243220
Received: May 16, 2014
Peer-review started: May 16, 2014
First decision: June 18, 2014
Revised: June 22, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: January 14, 2015
Abstract

AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) for patients with gall bladder stones (GS) and common bile duct stones (CBDS).

METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram (TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven CBDS.

RESULTS: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases (84.2%) where removal of stones were successful; passed stones in 6 cases (7.9%); short lower end stricture with small stones present in two cases (2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case (1.3%) which was treated by open hepaticojejunostomy; and one case (1.3%) was proved to be ampullary carcinoma and whipple’s operation was scheduled.

CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.

Keywords: Obstructive jaundice, Endoscopic retrograde cholangio-pancreatography, Gall stones

Core tip: The incidence of common bile duct stones (CBDS) in patents with gall bladder stones (GS) varies between 7% and 20%. Management of CBDS is changing with advances in endoscopic techniques in many regards. Laparoscopic cholecystectomy is the gold standard in treating GS. This has created controversies in the management of CBDS. The hepatobiliary surgeon should be trained in endoscopic retrograde cholangio-pancreatography as the third hand to expand his field of therapeutic options.