ERCP IN THE MANAGEMENT OF PATIENTS HAVING LAPAROSCOPIC CHOLECYSTECTOMY - RE-APPRAISING CURRENT INDICATIONS

This study assessed the ability of biochemical tests and ultrasound to predict the presence of ductal calculi, and thereby refine the indica tions for ERCP, in patients before or after laparoscopic cholecystecto my. Thirteen of fifty-three patients investigated before laparoscopic cholecystectomy, and four of seventeen investigated after had stones c onfirmed at ERCP. The most sensitive indices for stones were raised se rum alkaline phosphatase (0.76), aspartate transferase (0.75) and alan ine transferase (0.76). The most specific indices were an abnormal ult rasound (0.92), raised serum amylase (0.78) and raised bilirubin (0.75 ). Serum bilirubin, amylase and ultrasound were all normal in twenty-s even patients and all of these had normal ERCPs. If patients with norm al bilirubin, amylase and ultrasound were not referred for ERCP, no st ones would have been overloolked and the number of ERCPs could have be en reduced by 39%.