Patients with gallstone disease can present with elevated liver function tests.
It is often challenging to differentiate those with a common bile duct stone from those without a CBD stone on the basis of the liver function tests levels.
In this study, Dr Mahmoud Rahal evaluated the predictors of a common bile duct stones among patients presenting with symptomatic gallbladder disease and elevated liver function tests.
The team retrospectively examined all patients who had undergone a cholecystectomy between 2010 and 2015.
Patients with symptomatic cholelithiasis and increased liver function tests were included.
|Total bilirubin was highly predictive of common bile duct stones with a positive predictive value of 85%|
|European Journal of Gastroenterology & Hepatology|
Patient characteristics, imaging findings, lab findings, endoscopic interventions, and operative report were recorded and evaluated.
The diagnosis of common bile duct stones was made on the basis of ERCP and IOC findings.
The researchers included 354 patients in the final analysis.
Of these, 113 had confirmed choledocholithiasis.
The researchers noted that the prevalence of common bile duct stones among biliary colic, acute cholecystitis, and pancreatitis patients was 47%, 25%, and 26%, respectively.
The team found that γ-glutamyl transferase and direct bilirubin had the highest sensitivities for common bile duct stones among these patients.
In the setting of biliary colic, total bilirubin was highly predictive of common bile duct stones with a positive predictive value of 85%.
In the setting of acute cholecystitis, elevated liver function tests were even less significant in predicting stones, with a positive predictive value of less than 40% for most.
Dr Rahal's team concludes, "Although γ-glutamyl transferase and bilirubin levels showed a relatively higher sensitivity for common bile ducts compared with the other liver function tests, these were not reliable enough because of high false-positive as well as false-negative values, especially in patients presenting with acute cholecystitis".