Precholecystectomy ERCP in follow up cases of gallstone pancreatitis. Is it necessary?

Background/Objective: The need for a routine ERCP prior to cholecystectomy in all follow up cases of gallstone pancreatitis; the incidence of choledocholithiasis in these cases and to define radiological and biochemical criteria that would necessitate a precholecystectomy ERCP.
Materials and Methods: 42 patients of severe gallstone pancreatitis were treated in the hospital during the period 1st January - December 31st 2001. The severity of acute pancreatitis was based on Ranson's scoring system. All were conservatively managed during the initial phase of hospitalization, which ranged from 11-31 days. Standard radiological and biochemical investigations for acute pancreatitis were done in all cases. They were advised to undergo ERCP followed by cholecystectomy within 3-4 weeks. However only 36 patients came back for follow up and they form the study group. Ultrasound of abdomen and liver function tests were repeated in all of them prior to ERCP. All of them subsequently underwent cholecystectomy, 34 of them laparoscopically.
Results: Only 3(8.3%) had choledocholithiasis on ERCP. The CBD was cleared of stones during the same procedure and patients underwent cholecystectomy subsequently. Ultrasound showed choledocholithiasis in 2 and the alkaline phosphatase (AKP) and aspartate transaminases (AST) were raised in 2 patients.
Conclusion: A precholecystectomy ERCP should be performed in follow up cases of gallstone pancreatitis only if there are sonological features suggestive of choledocholithiasis and/or an elevation specifically of alkaline phosphatase and aspartate transaminase in the liver function tests.