Prevalence of Normal Liver Tests in Patients with Choledocholithiasis Undergoing Endoscopic Retrograde Cholangiopancreatography

Abstract

Background/Aims: Abnormal liver chemistry tests are a hallmark of common bile duct (CBD) stones. There is little information, however, on the prevalence of and predictors for normal liver chemistry tests in such patients. Methods: Over an 11-year period, all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at our Center were prospectively identified. Patients in this study were those with CBD stones found at ERCP and where the indication for ERCP was CBD stones seen on imaging studies or when CBD stones were highly suspected based upon clinical presentation and radiographic and laboratory findings. Liver chemistry tests were recorded from those taken at the time of initial presentation as well as the time closest to ERCP. Results: Of a total of 5,133 patients undergoing ERCP during the study period, the indication was suspicion for CBD stones or for radiographically identified CBD stones in 476 and 593, respectively, with 115 patients having both indications. Of these 1,184 patients, 765 had CBD stones of whom 541 had liver tests. Of these 541, 29 patients (5.4%) were found to consistently have normal liver chemistry tests. Multivariate analysis identified two factors predictive of normal liver tests including age >55 years and the presence of abdominal pain. Conclusions: Although rare, liver tests can be normal in patients with CBD stones. Patients most likely to have normal liver tests included older patients and those with abdominal pain.

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

“…We analyzed patients with preoperative suspicion of choledocholithiasis rather than all patients undergoing cholecystectomy, as our aim was to test the clinical utility of guidelines in preoperative suspected choledocholithiasis. This might have changed diagnostic accuracy only slightly, as two previous studies have shown that CBD stone with normal LFT is rare and accounts for only 1.69 % -5.4 % of all cases [15,16].…”

Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

“…The risk of having CBDSs in spite of normal LFTs and ultrasonography has been adequately evaluated in two studies [35,36]. In a large study including 765 patients with ERCPproven CBDSs, 541 had previously documented LFTs and 29 (5.4 %) had normal LFTs.…”

Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature

“…Furthermore, MRCP helps detect clinical relevant extrabiliary ductal diseases, which may also be responsible for a patient's symptoms [3] . Several studies have compared MRCP and ERCP, and most suggested patients should be examined with ERCP without prior MRCP when laboratory values or other imaging studies strongly suggest an abnormal hepatobiliary process such as a stone, stricture, or obstruction [8,9] . However, for patients who complain of right upper quadrant abdominal pain, without laboratory values or imaging studies that suggest an obstructive hepatobiliary or pancreatic process, many studies suggest using MRCP to determine whether ERCP is necessary in order to avoid useless morbidity [111] .…”