SELECTION CRITERIA FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATICOGRAPHY (ERCP) IN PATIENTS WITH GALLSTONE DISEASE

Endoscopic retrograde cholangiopancreatography (ERCP) has been used in patients referred for cholecystectomy when clinical information, bioc hemical values, or ultrasonography (clinical characterization) have in dicated possible presence of common bile duct stones, A retrospective study of 599 patients treated for gallstone disease was used to develo p a characterization procedure for predicting common bile duct stones by a discriminant analysis procedure, The variables selected by the an alysis as the best combination for CBDS prediction mere age (years), t he values of bilirubin (micromol/l), ALAT (U/l) and gamma GT (U/l), Th e characterization was false positive in 22 cases (3.7%) and false neg ative in 11 cases (1.8%), compared to 198 false positive cases (33.1%) and three false negative cases (0.5%) by the clinical characterizatio n. A leaving-one-out correction did not change the results. In a test set of 157 cholecystectomy patients, clinical characterization was fal se positive in 44.6% of the patients, compared to 4.5% false positive results when using the discriminant analysis procedure. The discrimina nt analysis procedure would have missed one patient with common bile d uct stones. Selection by the discriminant analysis characterization pr ocedure seems to reduce the frequency of preoperative ERCP significant ly without an increase in undetected common bile duct stones.