SCORE SYSTEM FOR ERCP INDICATING IN EXTRAHEPATIC BILE DUCT OBSTRUCTION
Abstracts. Aim: to objectify indications for urgent/emergency ERCP in patients with extrahepatic biliary tract obstruction (EBTO) by using the score system
Matherials and Methods. The score is used by summing the points: hyperthermia ≥ 37.3 ° C (1 point); one of three hematological points — leukocytosis ≥ 9×109/l or stab neutrophils ≥ 7% or the ratio of the number of segmented and stab neutrophils <10 (1 point); two biochemical — serum bilirubin ≥ 70 μmol / l (1 point), hyperamylasemia (1 point); thickening of the gallbladder wall ≥ 4 mm or shrunken gallbladder (1 point); the main pancreatic duct dilatation (1 point); in the presence of a periampular tumor or signs of chronic pancreatitis, one point is subtracted (- 1 point).
The scale was tested on 171 patients with EBTO.
Results. The threshold value of the scale was ≥3 points (p <0.001). The number of points (3, ≥4) correlated with the severity of acute cholangitis and acute biliary pancreatitis (p <0.01).
Conclusions. In patients with confirmed OEDB in case of ≤2 points of the score system — urgent/emergency ERCP is not indicated; in case of ≥3 points — urgent ERCP is indicated; in case of ≥4 points emergency ERCP should be performed.
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Proposed new simple scoring system to identify indications for urgent ERCP in acute cholangitis based on the Tokyo Guidelines.