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Selection Criteria for Preoperative Endoscopic Retrograde Cholangiopancreatography in the Laparoscopic Era
Gavin S. M. Robertson, MD, FRCS;
Carol Jagger, MSc, PhD, MFPHM;
Paul R. V. Johnson, MB, ChB, FRCS;
Barry J. Rathbone, MD, MRCP;
Anthony C. B. Wicks, MD, MRCP;
David M. Lloyd, MD, FRCS;
Peter S. Veitch, MB, BS, FRCS
Arch Surg. 1996;131(1):89-94.
Abstract
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Background
Indicators for cholangiography were originally designed to select patients at risk for common bile duct (CBD) stones for intraoperative cholangiography.
Objective
To refine these criteria to apply to the much more invasive procedure of preoperative endoscopic retrograde cholangiopancreatography (ERCP).
Design
Retrospective review of selection criteria for ERCP in consecutive patients referred over 18 months following the introduction of laparoscopic cholecystectomy.
Setting
Two ERCP units in adjacent teaching hospitals.
Patients
Three hundred seventeen patients with gallstones and in situ gallbladders.
Intervention
Common bile duct imaging at ERCP.
Main Outcome Measures
Abnormalities justifying ERCP.
Results
Abnormalities justifying ERCP were found in 66% of patients. This group differed significantly from those with normal ducts, with more being referred with abnormal results of all liver function tests (P<.001), jaundice (P<=.001 ), a dilated CBD on ultrasound (P<.001), or CBD stones on ultrasound (P<.001), On the other hand, patients with normal ducts were significantly more likely to have been referred with pancreatitis (P=.003) or elevated results of individual liver function tests (P<.001). A logistic regression model using age, presence of jaundice at ERCP, levels of alkaline phosphatase and albumin, and ultrasonography showing dilated ducts or visible CBD stones was found to have a specificity of 75% and a sensitivity of 89%. Past pancreatitis or elevated results of individual liver function tests were not predictive factors.
Conclusion
The use of such a model rather than individual criteria would improve the selection of patients for preoperative ERCP, optimizing its role in the laparoscopic era.
(Arch Surg. 1996;131:89-94)
Author Affiliations
From the Departments of Surgery (Drs Robertson, Johnson, and Lloyd) and Gastroenterology (Dr Rathbone), Leicester Royal Infirmary, the Departments of Surgery (Dr Veitch) and Gastroenterology (Dr Wicks), Leicester General Hospital, and the Department of Epidemiology and Public Health, University of Leicester (Dr Jagger), Leicester, England.
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