WHAT PREDICTS GASTROENTEROLOGISTS AND SURGEONS DIAGNOSIS AND MANAGEMENT OF COMMON BILE-DUCT STONES

Background: Because the literature suggests numerous indicators of com mon bile duct stones, we undertook a systematic assessment of physicia ns' judgments of the clinical utility of eight indicators: patient age , history of jaundice, history of pancreatitis, levels of serum alanin e aminotransferase, alkaline phosphatase, amylase, and total bilirubin , and common bile duct diameter on ultrasonography. Methods: Random sa mples of 1500 gastroenterologists and 1500 surgeons were sent a survey asking them to indicate the importance of each potential indicator of common bile duct stones, the likelihood of common bile duct stones fo r each of nine clinical vignettes, and whether they would order a preo perative ERCP. An abbreviated survey was sent to nonrespondents. Resul ts: Although there was substantial variation in the importances assign ed to each indicator, the most important indicators were serum total b ilirubin and diameter of common bile duct on ultrasound. The best pred ictors of the decision to order an ERCP were perceived likelihood of s tones and specialty. The average threshold for ordering an ERCP was 37 %. Respondents did not differ from nonrespondents in the perceived imp ortance of the eight indicators. Conclusions: The substantial variatio n among gastroenterologists and surgeons regarding the optimal approac h to common bile duct stones has clinical implications. Patients will receive varying recommendations for care, depending on whom they see.