UTILITY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE EVALUATION OF IDIOPATHIC ABDOMINAL-PAIN

We investigated the role of endoscopic retrograde cholangiopancreatogr aphy in 86 consecutive patients with idiopathic chronic or recurrent a bdominal pain. There were 18 males and 68 females with a mean age of 4 8 yr. Forty patients (47%) had previous cholecystectomy. Patients were divided into two groups: group I (normal serum alkaline phosphatase a nd total bilirubin) (n = 52), and group II (elevated serum alkaline ph osphatase and/or total bilirubin) (n = 34). Pancreatograms were normal in all patients, including five with pancreas divisum. Cholangiograms were abnormal in 10 of the 34 patients in group II (30%), and in only three of the 52 patients in group I (6%) (p = 0.003). Bile duct stone s were present in 18% of the patients in group II, and in none of the patients in group I (p = 0.003). Of the 40 post-cholecystectomy patien ts, four patients had bile duct stones and five had common bile duct d ilation without stones. However, no stones were found in any post-chol ecystectomy patients with normal liver tests. Of the 46 patients with gallbladder in situ, two patients with abnormal liver tests had common bile duct stones and two patients had common bile duct dilation witho ut stones. These results indicate that, among patients with idiopathic abdominal pain, cholangiography should be performed primarily in thos e with abnormal liver tests; however, further investigation with pancr eatography is unnecessary.