The Study on Necessity of ERCP in Patients with Symptomatic Gallhladder Stones / 대한소화기내시경학회지

ABSTRACT

BACKGROUND/AIMS: Laparoscopic cholecystectomy(LC) has become the new therapeutic gold standard in uncomplicated symptomatic gallbladder stone. However, some patients with gallstones may be associated with bile duct stones or other biliary pathology. LC is not ideal for removal and evaluation of biliary duct stones even with advocated techniques. Although ERCP is the best way to demonstrate the biliary tree, ERCP is an invasive procedure that may causes complications. The aim of this study was to predict the neeessity for ERCP and to determine the indication of ERCP before LC using noninvasive methods of biliary tree associated liver biochemistry(LB) parameters and sonography. METHODS: 270 symptomatic gallbladder stone patients were studied by both sonography and LB including total bilirubin, alkaline phophatase, gamma-glutamyltransferase and amylase. All patients were performd ERCP for evaluation of biliary tree pathology, Patients who were already found to have either tumors or bile duct stones on sonography were excluded. Patients were classified into normal and dilated biliary tree groups by sonographic findings, normal and abnormal LB groups, negative and positive ERCP groups. Positive ERCP were defined by bile duct stones, tumors, stricture and idiopathic common bile duct dilatation over 11 mm. RESULTS: 1) There were positive ERCP findings in 30.4% of all patients. 2) The male to female ratio was 12, and the patients of positive ERCP group (58.9 +/- 12.0) were significantly )p=0.000) older than negative group (52.7 +/- 13.1). 3) There was bile duct dilatation in 39.3% of patients by sonography. Bile duct dilatation on sonography had an 66.0% positive predictability, 85.3% sensitivity and 80.6% specificity for ductal pathology on ERCP. 4) There was abnormal LB in 53.0% of patients. A single abnormal LB equated to a 46.2% positive predictablity, 80.5% sensitivity and 59.0% specificity for ductal pathology on ERCP. 5) In patients with both normal sonography and LB, 96.0% of patients had a negative ERCP study. CONCLUSION: ERCP is not necessary before LC for patients with symptomatic gallbladder stones who have both a normal biliary tree on sonography and normal LB. But, a patient with either a dilated bile duct on sonography of an abnormal LB does require ERCP study.