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It is tempting to not recommend cholecystectomy in a patient who has undergone ERCP with stone extraction. Many feel that the rate of further trouble is too low to risk the morbidity of cholecystectomy and if the do develope further choledocholithiasis they can always have another ERCP.

However, this paper clearly shows that this wait and see policy is risky. 47% of patients who have had common bile duct stones cleared with ERCP will devlop further problems if the gall bladder is not removed. If gallbladder removal is delayed, the patient is more likely to require an open cholecystectomy and be deprived of the benefits of a laparoscopic procedure.

Adrian P. Ireland