Prediction of which patients with an abnormal intraoperative cholangiogram will have a confirmed stone at ERCP.
BACKGROUND
Abnormal intraoperative cholangiogram (IOC) findings are commonly evaluated using postoperative endoscopic retrograde cholangiopancreatography (ERCP). However, abnormal IOC studies are associated with high false-positive rates. This study aimed to identify a subset of patients with abnormal IOC who would benefit from a postoperative ERCP.


METHODS
This retrospective study investigated 68 patients with abnormal IOC at laparoscopic cholecystectomy (LC) who underwent postoperative ERCP at two tertiary referral centers over a 4-year period. Univariate and multivariate logistic regression analyses were performed to determine predictors of common bile duct (CBD) stones at postoperative ERCP. These predictors included: indication for LC, abnormal liver function tests, white blood cell count (WBC), amylase and lipase, abdominal ultrasound findings, and IOC findings [(1) non-passage of contrast into the duodenum, (2) single stone, (3) multiple stones, (4) dilated CBD, (5) non-visualization of the distal CBD, and (6) palpable CBD stones].


RESULTS
For all 68 patients, ERCP was successful. ERCP showed CBD stones in 36 cases (52.9%), and normal results in 32 cases (47%). On univariate and multivariate analysis, none of the variables included in this study significantly predicted stones at postoperative ERCP.


CONCLUSIONS
Approximately one-half of patients with an abnormal IOC have a normal postoperative ERCP. None of the parameters evaluated in this retrospective study helped identify patients who merit further evaluation by ERCP. The argument could be made that in patients with an abnormal IOC, less invasive methods such as endoscopic ultrasound or magnetic resonance cholangiopancreatography could be used postoperatively if symptoms arise to assess for possible retained stone.
Spinn
Matthew P
MP
Division of Gastroenterology, University of Texas Health Science Center, Medical School Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA. Matthew.P.Spinn@uth.tmc.edu
Wolf
David S
DS
Verma
Dharmendra
D
Lukens
Frank J
FJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007958:Leukocyte Count; D008049:Lipase / Q000032:analysis; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
D008049:Lipase; D000681:Amylases