Predictors of Preoperative ERCP Application Before Laparoscopic Cholecystectomy: A Retrospective Analysis

Objectives: Laparoscopic cholecystectomy (LC) has become the gold standard for treating symptomatic gallbladder stones, yet 3-10% of patients may also harbor common bile duct (CBD) stones, complicating their management.Endoscopic retrograde cholangiopancreatography (ERCP) revolutionized CBD stone treatment in the 1970s by offering a minimally invasive alternative to open exploration.However, the optimal approach for patients with suspected choledocholithiasis undergoing LC remains controversial.Methods: This retrospective study aimed to identify predictors for selective preoperative ERCP in 206 patients who underwent LC at SSK Okmeydani Training Hospital between June 1996 and June 1998.Clinical, biochemical, and radiological data were analyzed to determine the most significant predictors for ERCP.Key criteria included a history of cholangitis, gallstone pancreatitis, or jaundice; elevated bilirubin and alkaline phosphatase levels; and a CBD diameter 8 mm on ultrasonography.Results: ERCP was performed in 24 patients (11.65%), with successful outcomes in 22 cases.Among these, 16 patients (72.8%) had a CBD diameter 8 mm, and 13 (81%) had positive ERCP findings.Biochemical abnormalities were present in 14 patients (63.6%), with 8 (57.1%) showing positive ERCP results.Notably, 6 of 8 patients (75%) with normal biochemical results also had positive ERCP outcomes. Conclusion:The study highlights the importance of selective ERCP based on clinical and biochemical parameters, particularly in patients with a dilated CBD and abnormal liver function tests.These findings align with previous research advocating for risk stratification to minimize unnecessary ERCP procedures and associated complications.By refining preoperative evaluation criteria, this study supports a more targeted approach to ERCP use, optimizing patient outcomes while reducing procedural risks.