The diagnosis and management of bile duct abnormalities have been dramatically altered by the technological advances of the past decade. Imaging and intervention can be achieved in a variety of ways, requiring the collaborative work of the radiologist, gastroenterologist, and surgeon for optimal treatment strategies. This field is not static, but we must be cautious that the technology is not simply used for technology's sake, that the benefits, both clinical and cost, exceed the risks, and above all that we hold to the tenet primum non nocere.
The importance of this article is in emphasizing the need to be selective in using endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy. The initial excessive use of ERCP when laparoscopic cholecystectomy was first introduced has given way to more selective use of ERCP. The model defined in this article, yet to be tested prospectively, adds further refinement to selection criteria for ERCP.