title: A practical cost-effective management strategy for gallstone pancreatitis.
abstract: BACKGROUND
  The purpose of this study was to evaluate the outcomes of various surgeon strategies used to evaluate and treat common duct stones (CDSs) in patients presenting with mild to moderate gallstone pancreatitis (GP).
  
  
  METHODS
  We performed a retrospective review of patients admitted for mild to moderate GP. Data variables included laboratory values and radiology images, indications for and findings of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP), length of stay (LOS), and hospital charges. Data were stratified by 2 different management strategies: preoperative ERCP and then laparoscopic cholecystectomy (LC) or LC with IOC followed by selective postoperative ERCP.
  
  
  RESULTS
  During this time period, 80 patients met the study criteria, 56 were treated by LC with IOC, and 24 had a preoperative ERCP performed. The incidence of CDS was 33% (n = 26). The presence of CDSs correlated with an elevated total bilirubin at admission (CDSs 3.5 mg/dL vs 2.1 mg/dL no CDSs, P < .01) and 24 hours after admission (CDS 3.2 mg/dL vs 1.5 mg/dL no CDS, P < .01). Patients who had an IOC compared with those who had preoperative ERCP had a shorter LOS (4.6 vs 5.9 days, P = .04) and lower hospital charges (US $28,510 vs US $38,620; P < .01).
  
  
  CONCLUSIONS
  Elevated total bilirubin at admission and 24 hours after admission may predict a patient's risk for CDS. We found that the management of uncomplicated GP with early LC and IOC results in decreased LOS and total hospital charges when compared with preoperative ERCP.
authors: Department of Surgery, Stritch School of Medicine, Loyola University of Chicago, 2160 South First Avenue, Maywood, IL 60153, USA; Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.
authors: Lawrence E
authors: LE
authors: Tabone
authors: Molly
authors: M
authors: Conlon
authors: Emil
authors: E
authors: Fernando
authors: Sophia
authors: S
authors: Yi
authors: Sharfi
authors: S
authors: Sarker
authors: P Marco
authors: PM
authors: Fisichella
authors: Fred A
authors: FA
authors: Luchette
mesh_terms: D001663:Bilirubin / Q000032:analysis; D002758:Cholangiography / Q000191:economics; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay / Q000706:statistics & numerical data; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin
keywords: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Gallstone pancreatitis; Hospital charges; Intraoperative cholangiogram; Laparoscopic cholecystectomy