Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis.
BACKGROUND
Indications for endoscopic retrograde cholangiopancreatography (ERCP) are not precisely defined. With the increasing availability of magnetic resonance cholangiopancreatography (MRCP) and several prospective studies proving the accuracy of this modality, it is important to select appropriate criteria for invasive testing when common bile duct (CBD) pathology is suspected.


METHODS
We reviewed 200 consecutive ERCPs performed for jaundice, pancreatitis, noninvasive visualization of CBD stones, radiologic evidence of CBD dilatation, elevated liver function tests, or biliary colic. Diagnostic and therapeutic yields are determined for each indication and various combinations thereof.


RESULTS
Of the 180 ERCPs performed for suspected choledocholithiasis, 97 (53.8%) were performed for multiple indications, whereas 83 (46.2%) were performed for only one indication. One hundred two patients (56.6%) had CBD pathology, whereas 78 explorations (43.4%) were negative. If multiple indications for ERCP were present, the diagnostic yield was 85.6%. When there was only one indication, the diagnostic yield decreased to 25.3%.


CONCLUSIONS
ERCP is an invasive procedure with significant morbidity that should be used selectively. MRCP may be a more appropriate initial evaluation of suspected CBD pathology in many patients.
Sharma
S K
SK
Department of Surgery, Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ 07740, USA.
Larson
K A
KA
Adler
Z
Z
Goldfarb
M A
MA
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods* / Q000706:statistics & numerical data; D001651:Cholestasis, Extrahepatic / Q000453:epidemiology / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D042882:Gallstones / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies