title: Early endoscopic retrograde cholangiopancreatography in mild gallstone pancreatitis with deranged liver function test. A 7-year experience in central Saudi Arabia.
abstract: OBJECTIVE
  To determine the use of liver function tests (LFTs) as a selection tool for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with mild gallstone pancreatitis.
  
  
  METHODS
  All patients admitted with mild gallstone pancreatitis with deranged LFTs in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2006 and February 2013 were studied retrospectively. Patients' demography, symptoms, laboratory values, imaging studies, ERCP findings, complications and its treatment, surgical intervention, intraoperative and postoperative findings, mortality, and outpatient follow up were collected and analyzed.
  
  
  RESULTS
  A total of 245 patients were admitted as mild gallstone pancreatitis with admission day deranged LFTs. Pre-operative ERCP was performed in 74 patients based on admission day LFTs (Group A). Endoscopic retrograde cholangiopancreatography was normal in 65 patients, revealed stones in 5, and sludge in 4 patients. Six patients developed ERCP complications. Endoscopic retrograde cholangiopancreatography was deferred in 171 patients (Group B) until the LFTs were repeated in 3-4 days. Liver function tests remained persistently high in 8 patients. They were submitted to preoperative ERCP, which revealed stones (n=5) and sludge (n=3). Patients with normalized LFTs (n=163) were not submitted to ERCP. Three of them developed gallstone related complications.
  
  
  CONCLUSIONS
  Patients admitted with predicted mild gallstone pancreatitis, deranged LFTs, and no evidence of cholangitis should not be submitted to ERCP unless a repeat LFT within 3-4 days shows persistently deranged LFTs. This will reduce unnecessary ERCP and its complications.
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. Fax. +966 (11) 2075655. E-mail: Hamad_qah@hotmail.com.
authors.forename: Hamad H
authors.initials: HH
authors.lastname: Al-Qahtani
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Alam
authors.forename: Saleh
authors.initials: S
authors.lastname: Asalamah
authors.forename: Mohammed
authors.initials: M
authors.lastname: Akeely
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abrar
authors.forename: Reem
authors.initials: R
authors.lastname: Asalamah
authors.forename: Malak
authors.initials: M
authors.lastname: Al-Zahrani
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia; D055815:Young Adult