What are the indications for endoscopic retrograde cholangiopancreatography (ERCP) in the evaluation of biliary colic and acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Ultrasonography is 50-75% sensitive for choledocholithiasis; computed tomography (CT) and hepatic 2,6-dimethyliminodiacetic acid (HIDA) scanning are not better. Therefore, when a dilated common bile duct is found or elevated liver function test results are present, suspicion should remain high for common bile duct stones, and an ERCP should be considered.

Debate exists as to when an ERCP should be performed. In general, because cholecystitis is caused by obstruction of the ducts, the risk of common bile duct stones is approximately 10%. Given its potential for complications, ERCP should be used when there is a high potential for intervention and it should not be used solely as a diagnostic modality.

Some studies have classified people as low risk for common bile duct stones based on (1) lack of jaundice, (2) elevated transaminase levels, and (3) a common bile duct diameter of less than 8 mm. In this population, the risk of common bile duct stones may be as low as 1%. In patients with any of the risk factors, the rate of stones was 39%. Therefore, in general, people with any of the risk factors for common bile duct stones should undergo operative or ERCP evaluation of the common bile duct.


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