title: Qualification for endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of extrahepatic cholestasis caused by choledocholithiasis.
abstract: BACKGROUND
  Choledocholithiasis, being the most common cause of extrahepatic cholestasis, is diagnosed on the basis of clinical symptoms, laboratory findings, and imaging results. An important diagnostic and also therapeutic procedure performed in patients with choledocholithiasis is retrograde cholangiopancreatography (ERCP). However, due to the high rate of complications associated with ERCP, the decision on its implementation should be preceded by a thorough analysis of the case, aimed at confirmation of the diagnosis.
  
  
  METHODS
  The present study is a retrospective analysis of 86 patients qualified for ERCP due to suspected choledocholithiasis. The diagnosis was based on clinical symptoms and/or laboratory and/or imaging results. The presence of one or more of the three abovementioned criteria was a key to classify patients in one of three risk groups of choledocholithiasis: high, intermediate and low.
  
  
  RESULTS
  In the high-risk group, where choledocholithiasis was confirmed by clinical symptoms, laboratory findings and results of imaging tests, the accuracy of diagnosis was 100%. In the intermediate-risk group - choledocholithiasis diagnosed on the basis of clinical symptoms and laboratory results - the accuracy of diagnosis was approximately 81.5% (p < 0.05). In the low-risk group, in which choledocholithiasis was diagnosed only on the basis of clinical symptoms, diagnosis accuracy was approximately 50% (p < 0.05).
  
  
  CONCLUSIONS
  The combination of clinical symptoms, laboratory tests and imaging findings allows patients to be classified into three risk groups of choledocholithiasis: high, intermediate and low. Taking into account the probability of choledocholithiasis and the risk of ERCP complications, only patients from high and intermediate risk groups should be qualified for the procedure.
authors.affiliation: Gastrointestinal Endoscopy Laboratory, WAM University Hospital, Medical University of Lodz, Lodz, Poland; Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kujawski
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Stasiak
authors.affiliation: Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Rysz
keywords: choledocholithiasis; endoscopic retrograde cholangiopancreatography; extrahepatic cholestasis