ERCP in the assessment of patients with post-cholecystectomy syndrome: benefits and limitations

The aim of our study was to assess the diagnostic accuracy yielded by endoscopic retrograde cholangio-pancreatography (ERCP) in a group of 41 patients presenting with persistent or recurrent abdominal pain and/or cholestasis following cholecystectomy. Each patient had previously undergone, without success, a different combination of non-invasive tests. Cannulation with adequate opacification of at least one duct was achieved in all patients. Aetiologically diagnostic findings obtained with ERCP were as follows: normal 36.8%, choledocholithiasis 34%, benign biliary stenosis 9.8%, chronic pancreatitis 4.9%, pancreatic carcinoma 2.4%, ampullary carcinoma 2.4%, cholangiocarcinoma 2.4%, miscellaneous 7.3%. ERCP gave a final diagnosis in 26 patients (63%) and in all the cases presenting with cholestasis. ERCP plays a first-line role in the diagnostic assessment of patients with the post-cholecystectomy syndrome. However, there is still a considerable part of this population in whom ERCP does not contribute to a diagnosis.