SELECTIVE ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY AND PREOPERATIVE BILE-DUCT STONE REMOVAL IN PATIENTS SCHEDULED FOR LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE-STUDY

Objectives: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholelithiasis. About 10% of patients with symptomatic gallstones may bear associated common bile d uct (CBD) stones. The preferred approach to these patients is the remo val of CBD stones bg endoscopic retrograde cholangiography (ERCP) befo re LC, However, ERCP before LC should be performed only in patients wi th suspected choledocholithiasis. The aims of this study were to: 1) g enerate an efficacious predictive model for selecting patients with su spected choledocholithiasis to submit to preoperative ERCP, and 2) tes t the safety of the endoscopic/laparoscopic procedure. Methods: Histor ical, biochemical, and ultrasonographic data were collected prospectiv ely, Receiver operating characteristics curve analysis was adopted for determining optimal biochemical and ultrasonographic cut-off values, Multivariate analysis using logistic regression with generation of the best model identifying independent predictors of CBD stones was also employed, Results: The optimal model predicted a 95% probability of CB D stones in a patient who presented with elevated ALP (over 300 IU/L) and ALT (over 40 IU/L) levels and CPD dilation > 8 mm at ultrasonograp hy. Endoscopic removal of CBD stones was achieved in 95% of patients, with minimal morbidity and no mortality, Conclusions: The identified i ndependent predictors of CBD stones are highly efficient selectors of patients with choledocholithiasis. Moreover, endoscopic removal of CBD stones before LC is a safe and efficacious procedure.