Since ERCP is a highly complex gastroenterological procedure with morbidity risks of between 5% and 19%, and mortality risks of up to until 2.3% 8, the performance of this procedure must be exclusively therapeutic and not diagnostic. When the choledocolithiasis probability is average or low, these results support the necessity of using another diagnostic tool such as the endoscopic ultrasound scan prior to performance of ERCP performance. This will decrease the comorbidity rate and mortality risk for patients and offer better conditions for the security of gastroenterologists 9,10. 2. Gross BH, Harter LP, Gore RM, Callen PW, Filly RA, Shapiro HA, et al. Ultrasonic evaluation of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography. Radiology 1983; 1462: 471-474. 3. Tse F, Liu L, Barkun AN, ArmB D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc 2008; 672: 235-244. 4. Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 1028: 1781-1788. 5. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 2006; 206: 981-996. 6. Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin North Am 2008; 924: 925-960. 7. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, et al. Complications of ERCP. Gastrointest Endosc 2003; 576: 633-638. 8. Jüngst C, Kullak-Ublick GA, Jüngst D. Gallstone disease: Microlithiasis and sludge. Best Pract Res Clin Gastroenterol 2006; 206: 1053-1062. 9. ASGE Guideline. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointestinal Endoscopy 2010; 711: 1-9. 10. Petrov MS, Savides TJ. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. British Journal of Surgery 2009; 96: 967-974.
Se recomienda, considerando la CPRE como un procedimiento de alta complejidad en gastroenterología, con riesgo de morbilidad de 5% a 19% y mortalidad de hasta del 2,3% 8 que su realización debe ser exclusivamente terapéutica mas no diagnóstica; estos resultados apoyan la necesidad del uso de otra herramienta diagnóstica como por ejemplo la ultrasonografía endoscópica previa a la realización de CPRE, cuando la probabilidad de coledocolitiasis es de media o baja probabilidad, disminuyendo el riesgo de comorbilidad y mortalidad para el paciente y brindando mayor seguridad para el gastroenterólogo 9, 10.