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Predictors of bile tree pathology in patients presenting with gallbladder disease

Rahal, Mahmoud A.a; Rammal, Mohammad O.a; Karaoui, Walida; Hallal, Alib; Tamim, Hanic; Shaib, Yassera

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p 1017–1021
doi: 10.1097/MEG.0000000000000910
Original Articles: Biliary Disorders

Background Patients with gallstone disease can present with elevated liver function tests (LFTs). It is often challenging to differentiate those with a common bile duct (CBD) stone from those without a CBD stone on the basis of the LFTs levels. In this study, we aim to evaluate the predictors of a CBD stones among patients presenting with symptomatic gallbladder disease and elevated LFTs.

Patients and methods We retrospectively examined all patients who had undergone a cholecystectomy between January 2010 and December 2015. Patients with symptomatic cholelithiasis and increased LFTs were included. Patient characteristics, imaging findings, lab findings, endoscopic interventions, and operative report were recorded and evaluated. The diagnosis of CBD stones was made on the basis of ERCP and IOC findings.

Results We included 354 patients in the final analysis. Of these, 113 (32%) had confirmed choledocholithiasis. The prevalence of CBD stones among biliary colic, acute cholecystitis, and pancreatitis patients was 47, 25, and 26%, respectively. γ-Glutamyl transferase and direct bilirubin had the highest sensitivities for CBD stones among these patients (83 vs. 79%). In the setting of biliary colic, total bilirubin was highly predictive of CBD stones with a positive predictive value of 85%. In the setting of acute cholecystitis, elevated LFTs were even less significant in predicting stones, with a positive predictive value of less than 40% for most.

Conclusion Although γ-glutamyl transferase and bilirubin levels showed a relatively higher sensitivity for CBDS compared with the other LFTs, these were not reliable enough because of high false-positive as well as false-negative values, especially in patients presenting with acute cholecystitis.

Departments of aInternal Medicine, Division of Gastroenterology


cBiostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon

Correspondence to Yasser Shaib, MD, MPH, FASGE, Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, PO Box 11-0236, 1107 2020 Beirut, Lebanon Tel: +961 135 0000 x7299; fax:+961 135 0000 x7940; e-mail:

Received March 31, 2017

Accepted April 26, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.