Das diagnostische und therapeutische Management bei symptomatischer Cholezystolithiasis und präoperativ bestehendem Verdacht auf eine Choledocholithiasis

The goal of this study was to examine the effectiveness of endoscopic retrograde choledocho-pancreatography (ERCP) at the Unfallkrankenhaus Berlin in the setting of pre-operative suspicion of choledocholithiasis. The predictive value of various pathologic findings with regard to choledocholithiasis was to be determined in this patient population. All patients treated operatively for symptomatic cholecystolithiasis between August 2000 and August 2001 were evaluated retrospectively for the following variables: age, gender, operative strategy, intra-operative cholangiography, sonographic findings, occurrence of choledocholithiasis. In 21.4% of 196 patients who underwent cholecystectomy (n = 42) a pre-operative ERCP was performed. In 19 of these 42 patients, no pathology was found on ERCP. The percentage of therapeutic pre-operative investigations was 47.6% (n = 20). In 3 patients, a juxtapapillary diverticulum was seen. 69.9% of the operations (n = 137) were performed laparoscopically.167 patients (85.2%) underwent intra-operative cholangiography. In 4 patients, the ERCP was performed post-operatively. The indication for 3 of those 4 examinations was an abnormal intra-operative cholangiogram. Complications occurred in 4 of the 46 patients who underwent ERCP (8.7%). Choledocholithiasis was found in 12.2 % (n = 24) of all 196 patients. The pathologic finding with the highest positive predictive value for the diagnosis of choledocholithiasis was the finding of dilated common bile duct to more than 8 mm diameter (PPV 75%). Among laboratory variables investigated in this study, the elevation of serum bilirubin level exhibited the highest positive predictive value (PPV 39.2 %).