Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002

doi:10.3748/wjg.v10.i23.3495

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Research

World J Gastroenterol. Dec 1, 2004; 10(23): 3495-3499
Published online Dec 1, 2004. doi: 10.3748/wjg.v10.i23.3495

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002

Laszlo Lakatos, Gabor Mester, Gyorgy Reti, Attila Nagy, Peter Laszlo Lakatos

Laszlo Lakatos, Gabor Mester, 1^st Department of Medicine, Csolnoky F, Province Hospital, Veszprem, H-8200 Hungary

Gyorgy Reti, Attila Nagy, Department of Surgery, Csolnoky F, Province Hospital, Veszprem, H-8200 Hungary

Peter Laszlo Lakatos, 1^st Department of Medicine, Semmelweis University, Budapest, H-8200 Hungary

Author contributions: All authors contributed equally to the work.

Correspondence to: Laszlo Lakatos, M.D., PhD, 1^st Department of Medicine, Csolnoky F, Province Hospital, Korhaz u.1, Veszprem, H-8200 Hungary. laklaci@hotmail.com

Telephone: +36-20-9119339 Fax: +36-1-3130250

Received: April 4, 2004
Revised: April 22, 2004
Accepted: May 25, 2004
Published online: December 1, 2004

Abstract

AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: Patients undergoing preoperative ERCP ( ≤ 90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct ( ≥ 8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient’s history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP.

RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%.

CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools).

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