[Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy. Results of a 7-year, retrospective, single center study].
The optimal treatment for bile duct stones (in terms of accuracy, complications and cost) is unclear. The aim of our study was to determine the predictive factors for preoperative ERCP.


METHODS
Patients who underwent preoperative ERCP (= 90 days before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st January 1996 to the 31st December 2002. The indication for ERCP was elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (> or = 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 combination of factors were compared to the results of the ERCP.


RESULTS
206 preoperative ERCP-s were performed during the observed period, 200 were successful (97.1%). Bile duct stone was detected in 81 patients (39.3%), it was 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%.


CONCLUSIONS
The practical conclusion of this study is that preoperative ERCP is highly recommended in patients with three or more positive factors. In contrast, ERCP is not indicated in patients with zero or one factor. Preoperative ERCP should be offered to patients with two positive factors, however the practice should be based also on the local conditions (e.g. skill of the endoscopist, other diagnostic tools).
Lakatos
László
L
Csolnoky Ferenc Kórház, I. Belgyógyászati Osztály, Veszprém. lakatosvmkgastro@hotmail.com
Simon
László
L
Mester
Gábor
G
Réti
György
G
Nagy
Attila
A
Lakatos
Péter László
PL
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
A praeoperatív endoszkópos retrográd cholangiopancreatographia (ERCP) szelekciós kritériumai laparoszkópos cholecystectomia elott egy centrum hétéves adatainak retrospektív elemzése alapján.