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  1. Bile duct stones and laparoscopic cholecystectomy : a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP.

    Article, Communication - En anglais

    Annual meeting of the International Society for Technology Assessment in Health Care. Barcelona, ESP, 1997.

    Background 

    The least costly management strategy for patients undergoing laparoscopic cholecystectomy is unclear.

    Methods 

    A decision model incorporating cost ratios, test accuracy, complication, and failure rates was used to determine the costs of 4 peri-laparoscopic cholecystectomy strategies : endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography (IOCG), endoscopic ultrasound (EUS), and expectant management.

    Results 

    Expert IOCG is least costly for intermediate-risk patients when the risk of stones is between 17% and 34%. If expert EUS is available, 0% to 10% ( « low » risk) merits expectant management ; 11% to 55% ( « intermediate » risk) merits EUS ; and greater than 55% ( « high » risk) merits ERCP.

    Thresholds were most sensitive to changes in the risks of symptoms and complications due to retained stones ; and to procedural costs, sensitivity, and success rates.

    Neither IOCG nor EUS appears likely to reduce overall costs unless their accuracy and success rates are greater than 90% and their procedural cost is less than 60% to 70% that of ERCP.

    When neither are available, ERCP is preferable when the risk of stones is greater than 22%. Thresholds were relatively insensitive to changes in the risk and severity of ERCP-induced pancreatitis. (...)

    Mots-clés Pascal : Lithiase, Vésicule biliaire, Traitement, Cholécystectomie, Laparoscopie, Indication, Coût, Complication, Incidence, Voie biliaire, Association morbide, Etude comparative, Evaluation performance, Homme, Voie biliaire pathologie, Appareil digestif pathologie, Chirurgie endoscopique, Economie santé

    Mots-clés Pascal anglais : Lithiasis, Gallbladder, Treatment, Cholecystectomy, Laparoscopy, Indication, Costs, Complication, Incidence, Biliary tract, Concomitant disease, Comparative study, Performance evaluation, Human, Biliary tract disease, Digestive diseases, Endoscopic surgery, Health economy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0172890

    Code Inist : 002B25G03. Création : 16/11/1999.