PRE-PROCEDURE PREDİCTORS OF UNNECESSARY ERCP

Aims Our aim was to evaluate the risk of unnecessary endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected common bile duct (CBD) stones before the procedure.

Methods In a retrospective single-center study, we investigated the ERCP records between 12.2016- 04.2021. 30 patients with malignancy were excluded. All patients had abdominal imaging before the ERCP. Laboratory parameters were derived at the time of admission. Statistical analyses were performed using SPSS. ROC curve analysis was used to determine the cut-off values.

Results Out of 237 patients, CBD stones were removed from 128 patients (54%). 131 (55.3%) patients had choledocholithiasis, 31 patients (13.1%) had pancreatitis, 32 patients (13.5%) had cholangitis, and the rest 43 patients (18.1%) had cholestasis at the time of admission. There was a significant difference between groups by means of ALP, total bilirubin, direct bilirubin, CBD stone diameter, and CBD diameter (p<0.001). According to the ROC curve analysis, the best cut-off ALP to differentiate between groups was 223 IU/L (Sens:67; Spec:67), best cut-off total bilirubin value was 3.45 mg/dL (Sens:76; Spec:76), best cut-off direct bilirubin value was 1.75 mg/dL (Sens:81; Spec:71), best cut-off CBD diameter value was 9.75 mm (Sens:52; Spec:60), and best cut-off CBD stone diameter value was 3.2 mm (Sens:62; Spec:87).

Conclusions Among all parameters, ALP, total bilirubin, direct bilirubin, CBD diameter, CBD stone diameter were statistically significant. The cut-off values were 223, 3.45, 1.75, 9.75, 3.2 respectively. Thus, both parameters may be used to predict unnecessary ERCP. Large-scale, prospective studies are needed for further conclusions.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2022