ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE MANAGEMENT OF POST­ CHOLECYSTECTOMY COMPLICATIONS

Abstract

After cholecystectomy, 30-40% of patients have been reported to•

suffer from recurrent biliary pain.

Retained bile duct calculi, leakage of bile, and bile duct injury are the main biliary complications of cholecystectomy.

Biliary complications of cholecystectomy may be managed percutaneously, surgically, endoscopically, or a mix thereof, depending on the type, severity, and time of recognition of the complication.

ERCP is the most useful test for the definitive diagnosis of major bile duct complications. It detects retained calculi, stricture, overlooked tumors, bile leakage from the cystic duct stump or from a lateral duct injury, or complete obstruction of the distal duct.

ERCP will provide an accurate diagnosis in the vast majority of cases, it IS usually more accurate than cholangiography via the T-tube when present, and is less invasive than percutaneous cholangiography, particularly in patients with non dilated bile ducts. The evaluation of patients who are symptomatic after cholecystectomy may include other diagnostic modalities, such as extracorporeal ultrasound, computed tomography, hepatobiliary scintigraphy, and biliary magnetic resonance imaging. These non invasive diagnostic tests, when used correctly, can significantly decrease the need for post-operative ERCP, restricting it to those needing therapeutic procedures only. The major role of ERCP or PTC is to provide exact anatomical diagnosis while, at the same time, allowing for treatment in many instances. Because of a defined incidence of bleeding and bile leakage associated with