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PubMed · 3669349

[New therapeutic methods--technics, application, efficiency and problems--endoscopic biliary drainage. c) Application of endoscopic retrograde biliary drainage to therapy of cholelithiasis].

S Fujimoto·M Nakajima·S Yoshida·K Yasuda·M Kobayashi·E Cho·K Nishimura·K Kiyota·A Matsui·W Imaoka
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Cholangiopancreatography, Endoscopic RetrogradeCholelithiasisDrainageHumansJournal Article

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S Fujimoto, M Nakajima, S Yoshida, K Yasuda, M Kobayashi, E Cho, K Nishimura, K Kiyota, A Matsui, W Imaoka. 1987. [New therapeutic methods--technics, application, efficiency and problems--endoscopic biliary drainage. c) Application of endoscopic retrograde biliary drainage to therapy of cholelithiasis].. https://pubmed.ncbi.nlm.nih.gov/3669349/

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Optimizing choledocholithiasis management: a cost-effectiveness analysis.

HYPOTHESIS: Endoscopic retrograde cholangiopancreatography (ERCP) is more cost-effective for managing incidental choledocholithiasis (CDL) after laparoscopic cholecystectomy and intraoperative cholangiogram (LC/IOC) than laparoscopic common bile duct exploration (LCBDE). DESIGN: A cost-effectiveness analysis was performed to compare ERCP with LCBDE. Sensitivity analyses were performed to determine the key contributors to cost-effectiveness between the 2 treatment options. SETTING: Costs were approached from the institutional perspective considering a typical patient undergoing LC/IOC at a large referral center. PATIENTS: The base case patient evaluated was a woman 18 years of age or older with symptomatic cholelithiasis and incidental CDL discovered at the time of LC/IOC. INTERVENTIONS: Endoscopic retrograde cholangiopancreatography with drainage procedure performed after LC/IOC or LCBDE during LC/IOC. MAIN OUTCOME MEASURES: Costs, quality-adjusted life years gained, mean cost-effectiveness ratios, and incremental cost-effectiveness ratios. RESULTS: In the base case analysis, ERCP was the optimal treatment choice with a cost of $24 300 for 0.9 quality-adjusted life years gained compared with $28 400 and 0.88 quality-adjusted life years for LCBDE. Endoscopic retrograde cholangiopancreatography remained the optimal strategy for CDL in multiway probabilistic sensitivity analysis. If LCBDE were performed and the cost of a potential operative case lost was $3100 or less and the cost of ERCP hospitalization was $18 000 or more, then LCBDE became the preferred treatment for CDL. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography was both less costly and more effective than LCBDE. Factors important to choosing the best strategy for CDL management included the cost of a potential case lost due to LCBDE performance and the cost of ERCP hospitalization.

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