What predicts gastroenterologists and surgeons diagnosis and management of common bile duct stones?
” Gastrointestinal Endoscopy 46(1), pp. 40-47, 1997. Because surgeons performing laparoscopic cholecystectomy cannot directly observe and feel for common bile duct stones as in open cholecystectomy, physicians must rely on laboratory and diagnostic test results and elements of the history and physical examination. Common indicators include patient age, history of jaundice or pancreatitis, common bile duct diameter on ultrasound, and levels of serum alanine, aminotransferase, alkaline phosphatase, amylase, and total bilirubin. The researchers surveyed a random sample of 1,500 gastroenterologists and 1,500 surgeons on the importance they gave to each potential indicator of common bile duct stones, the likelihood that stones were present for each of nine clinical vignettes, and whether they would order a preoperative endoscopic retrograde cholangiography (ERCP, x-ray of the common bile duct following infusion into the duct of a contrast dye). Even though most gastroenterologists and surge
