SELECTION CRITERIA FOR PREOPERATIVE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE LAPAROSCOPIC ERA

Background: Indicators for cholangiography were originally designed to select patients at risk for common bile duct (CBD) stones for intraop erative cholangiography. Objective: To refine these criteria to apply to the much more invasive procedure of preoperative endoscopic retrogr ade cholangiopancreatography (ERCP). Design: Retrospective review of s election criteria for ERCP in consecutive patients referred over 18 mo nths following the introduction of laparoscopic cholecystectomy. Setti ng: Two ERCP units in adjacent teaching hospitals. Patients: Three hun dred seventeen patients with gallstones and in situ gallbladders. Inte rvention: Common bile duct imaging at ERCP. Main Outcome Measures: Abn ormalities justifying ERCP. Results: Abnormalities justifying ERCP wer e found in 66% of patients. This group differed significantly from tho se with normal ducts, with more being referred with abnormal results o f 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 o f individual liver function tests (P<.001). A logistic regression mode l using age, presence of jaundice at ERCP, levels of alkaline phosphat ase 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 functi on tests were not predictive factors. Conclusion: The use of such a mo del rather than individual criteria would improve the selection of pat ients for preoperative ERCP, optimizing its role in the laparoscopic e ra.