Diagnostic and therapeutic value of ERCP and prediction of outcome: a retrospective analysis

The objective is to analyze the experience of using diagnostic and therapeutic ERCP and to attempt identifying the independent factors that predict positive and useful procedures. The medical records of 198 patients seen during the period 1991-1993 were retrospectively reviewed. There were 102 males and 96 females with a mean age of 45.2 SD + 16.7 years. The main indications for performing the procedure were jaundice, abdominal pain, nausea and/or fever. Laboratory tests showed elevated direct bilirubin in 50% of patients, deranged liver enzymes in 43%, and ESR was raised in 51% and fever was documented in 52% of patients. The cannulation of both ducts was successful in 93% of all procedures. The commonest finding was gallbladder and common bile duct stones (CBD). In 54 patients out of 64 with CBD stones, stones were removed endoscopically. Stepwise regressive analyzis has identified age above 40 years, presence of jaundice (total bilirubin > 2.5 mg/ml) and raised ESR (> 25 mm in the 1st hour) as significant factors that independently predict a positive ERCP that revealed findings previously unknown (useful procedure). Diagnostic and therapeutic ERCP is an integral part in management of biliary and pancreatic ducts disorders. The validity of clinical prediction role should be tested prospectively.