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

Table 1 Number of ERCP and/or LC cases per year in the Csolnoky Ferenc Hospital, Veszprém, Hungary

Year	ERCP	LC	ERCP-LC
1996	373	99	15
1997	393	164	28
1998	375	140	27
1999	490	189	33
2000	558	183	36
2001	378	246	42
2002	391	227	25
Total	2258	1248	206
Average	423/yr	178	29/yr

Table 2 Preoperative ERCP, age and gender of patients (n = 206)

Gender	n (%)	Mean age
Male	48 (23)	57.4
Female	158 (77)	51.0
Total	206 (100)	52.5

Table 3 Results of preoperative ERCPs performed prior to LC (n = 206)

ERCP finding	n	%
Common bile duct (CBD) stone	81	39.3
Negative	119	57.8
CBD not filled	6	2.9
Successful EST and duct clearance	79/81	97.5
Complication	3	1.5
-bleeding	1	0.5
-pancreatitis	1	0.5
-stone impaction	1	0.5

Table 4 Common bile duct stones in cases of different posi-tive prognostic factors (PPF)

Factor	Number	Stone	Negative	Unsuccessful	%
Hyperbilirubinaemia ( > 2)	61	44	16	1	72
Elevated ASAT/ALAT ( > 50%)	116	74	39	3	64
Elevated GGT/ALP ( > 50%)	134	79	52	3	59
Acute pancreatitis (AP)	26	18	7	1	69
AP in the anamnesis	20	4	16	0	20
Jaundice in the anamnesis	29	1	26	2	3
US: CBD ≥ 8 mm	53	38	14	1	71
US: bile duct stone	7	4	3	0	57
Biliary colic	106	62	42	2	58

Table 5 Total predictive value of different positive predictive factors (PPF) for common bile duct stone

Factor	PPV %	NPV %	Sensitivity %	Specificity %
Hyperbilirubinaemia	73.3	73.6	54.3	86.6
Elevated ASAT/ALAT	65.4	91.9	91.3	67.2
Elevated GGT/ALP	60.3	97.1	97.5	56.3
Acute pancreatitis (AP)	72.0	73.5	22.2	96.2
AP in the anamnesis	20.0	57.2	4.9	86.5
Jaundice in the anamnesis	3.7	53.7	1.2	78.2
US: CBD ≥ 8 mm	73.1	70.9	46.9	88.2
US: bile duct stone	57.1	60.1	4.9	97.5

Table 6 Predictive value of positive predictive factors (PPF) for CBD stones and effect of associated other factors, n (%)

Factor	Alone	One further factor	Two or more further factors
Hyperbilirubinaemia	0/3	1/5 (20)	43/53 (81)
Elevated ASAT/ALAT	1/11 (9)	13/32 (41)	60/73 (82)
Elevated GGT/ALP	1/24 (4)	16/35 (46)	62/75 (83)
Acute pancreatitis (AP)	-	0/3	18/23 (78)
AP in the anamnesis	1/12 (8)	0/3	3/5 (60)
Jaundice in the anamnesis	0/27	1/2 (50)	-
US: CBD ≥ 8 mm	0/7	6/11 (55)	32/35 (91)
US: bile duct stone	0/1	-	4/6 (67)

Table 7 Association between the number of positive predic-tive factors and ERCP findings (n = 206)

Number of positive factors	Number	Stone	Negative	Unsuccessful	%
1	84	1	80	3	1.2
2	46	19	25	2	43.1
3	40	29	11	0	72.5
≥ 4	36	32	3	1	91.4

P < 0.00001 for the whole group, P < 0.00001, between group 1 and groups 2, 3, 4, group 2 and group 4, P = 0.008, between groups 2 and 3, P = 0.035, between groups 3 and 4.

Table 8 Predictive value of predictive factors according to the number of positive factors

Number of positive factors	Number	PPV %	NPV %	Sensitivity %	Specificity %
1	84	1.2	-	-	-
2	46	43.1	98.7	95.2	76.1
3	40	72.5	84.0	59.1	90.5
≥ 4	36	91.4	72.0	40.2	98.4

P < 0.00001 for the whole group, P < 0.00001, between group 1 and groups 2, 3, 4 and group 2 and group 4, P = 0.008, between groups 2 and 3, P = 0.035, between groups 3 and 4.