RESUMEN
Background: Endoscopic retrograde cholangiopancreatography [ERCP] with stone extraction is the gold standard for the management of common bile duct [CBD] stones. Many scoring systems had developed aiming at prediction of CBD stones prior to cholecystectomy to avoid unnecessary ERCP. On the other hand Magnetic Resonance Cholangiopancreatography [MRCP] had proved efficiency in diagnosis of CBD stones and was replacing ERCP in some centers but with additional cost for therapeutic ERCP in case of CBD stones
Aim of the work: the aim of this study was to evaluate the validity of the scoring system, predicting CBD stones, in selecting patients with suspected CBD stones for ERCP or MRCP prior to cholecystectomy
Patients and methods: One hundred twenty consecutive patients with cholelithiasis and suspected CBD stones were enrolled in this study between July 2001 and Dec. 2004. They were randomized into three groups, group 1 for ERCP, group 2 for MRCP followed by ERCP if there was stone and group 3, according to the scoring system, for either MRCP if the score is < 4 or ERCP if the score is >/= 4
Results: CBD stones were found in 67 out of 120 patients [56%]. The success rate for diagnostic ERCP was 100%, and successful therapeutic ERCP was 98.5%. The incidence of unnecessary ERCP was reduced significantly from 40% [Group 1] to 5.9% [Group 3A] [P< 0.001]. Also additional ERCP after +ve MRCP was reduced significantly from 55% [Group 2] to 21.7% [Group 3A] [P <0.05]
Conclusion: This study confirms the validity of this new scoring system, predicting CBD stones, in selecting patients for ERCP or MRCP prior to cholecystectomy to avoid unnecessary ERCP