Clinical Research
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
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, 1st 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, 1st 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, 1st Department of Medicine, Csolnoky F, Province Hospital, Korhaz u.1, Veszprem, H-8200 Hungary.
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

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 1st of January 1996 to the 31st 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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