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VOLUME 12 , ISSUE 2 ( May-August, 2023 ) > List of Articles

ORIGINAL RESEARCH

Choledocholithiasis: Easy and Early Diagnosis

Doris Sarmiento, Antonella Gallegos, Mateo Pacurucu, Rafael Valdivieso, Catherine Cabrera, Amber N Himmler

Keywords : Cholangiopancreatography endoscopic retrograde, Choledocholithiasis, Common bile duct, Liver function tests

Citation Information : Sarmiento D, Gallegos A, Pacurucu M, Valdivieso R, Cabrera C, Himmler AN. Choledocholithiasis: Easy and Early Diagnosis. Panam J Trauma Crit Care Emerg Surg 2023; 12 (2):76-79.

DOI: 10.5005/jp-journals-10030-1418

License: CC BY-NC 4.0

Published Online: 19-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aims and objectives: Choledocholithiasis is prevalent in Western countries, representing 10–15% of symptomatic gallstones, and is associated with a high-risk of complications (1–2%). The primary objective of the study is to determine the validity of liver function tests (LFTs) early, as well as establish LFT cutoff values. In this way, there will be greater accuracy in diagnosing this condition, and a reduced need for subsequent endoscopic retrograde cholangiopancreatography (ERCP), which is particularly beneficial for hospitals with limited resources. Materials and methods: This is an analytical study for the validation of diagnostic tests for choledocholithiasis. The inclusion criteria were patients over the age of 16 with a suspected diagnosis of choledocholithiasis who underwent ERCP (gold standard). Demographic data and LFTs were analyzed, including total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), and alkaline phosphatase (ALP). LFTs were compared between patients with ERCP-confirmed choledocholithiasis vs patients with negative findings on ERCP, thus obtaining sensitivity, specificity, and predictive values. Results: A total of 262 patients who underwent ERCP were included in the study, of which 167 patients (63.7%) had confirmed choledocholithiasis. The most sensitive LFTs were ALT (87.43%) and GGT (87.43%), while those with the highest specificity were AST (82.11%), and GGT (80%). All the tests obtained an area under the curve greater than 0.83, and specific LFT cutoffs were established. Conclusion: All LFTs had high sensitivity for a successful diagnosis of choledocholithiasis, most notably AST and GGT. Our findings demonstrated that a raised AST and GGT served as valid markers in raising an early suspicion of choledocholithiasis, thus expediting the diagnostic process and preventing unnecessary ERCP. As ERCP is not widely available in hospitals in low to middle-income countries, these findings have strong implications for hospitals with limited resources.

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