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.
Patients and 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).