[Endoscopic cholangiography in mild XXXX : when and for whom?].

@entity1 @entity788 @entity1087 @entity656 @entity384 @entity648 @entity5990 @entity158 @entity255 @entity2877
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP), with or without sphincterotomy, has been widely used in @entity1 with severe @entity656 ( @entity656 ) or those with @entity255 and/or obstruction of the biliary tree. Its use in subjects with mild @entity656 is more controversial. AIM: To optimize use of ERCP in @entity1 with mild @entity788 due to @entity5990 by identifying clinical and biochemical predictors of @entity2877 . MATERIAL AND METHOD: The clinical and biochemical data, images, and outcomes of 83 @entity1 with mild @entity656 hospitalized at the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" from January 1, 1988 to May 30, 2000 were retrospectively analyzed. All @entity1 received elective cholecystectomy at hospital admission. In 35 cases, ERCP was performed before cholecystectomy (group A). The remaining 48 were operated on without ERCP (group B). In 30, transcystic-cholangiography was done. Forty-seven (57%) were female. Mean age was 47 years (19-90). Mean time between onset of AP and hospital admission was 2.2 days (1-15), and between clinical onset and cholecystectomy, eight days (1-26). Statistical differences were evaluated by non-parametric methods. An univariated and multivariated analysis was performed looking for data to identify @entity2877 . RESULTS: @entity2877 was found in 27 cases (32%), 18 from group A (51%), and nine for group B (19%) (RR = 4.58, IC 95% = 1.7-12.25, p = 0.004). ERCP was performed in all cases because of clinical suspicion of @entity2877 ( @entity1087 , @entity648 , and alkaline phosphatase alteration and/or @entity384 ); however, none of the @entity1 of group B in whom @entity2877 was operatively diagnosed showed biochemical or radiologic alterations. Subjects with choledocolithiasis presented more frequently a history of @entity158 (RR = 5.75, IC 95% = 1.76-18.7), @entity1087 (RR = 3.07, IC 95% = 1.15-8.16) and/or alkaline phosphatase elevation (RR = 4.11, IC 95% = 1.3-12.7). CONCLUSION: The high frequency of @entity2877 in subjects with mild @entity788 warranted radiologic exploration of the biliary tree in all @entity1 submitted to cholecystectomy. In those with @entity1087 , alkaline phosphatase elevation and/or a history of @entity158 , ERCP should be performed prior to the operation; in others, @entity2877 can be discharged by operative transcystic cholangiography. Therapeutic measures for treating @entity2877 should be adapted to hospital facilities.
