Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis

Peng, Wu; Sheikh, Zara; Paterson-Brown, Simon; Nixon, S. J.

doi:10.1002/bjs.4955

Cited by 118 publications

(109 citation statements)

References 17 publications

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“…On the other hand, severity of acute cholecystitis also had no significant influence on the level of serum aminotransferases [11] . Jaundice is a common feature of patients with CBD stones [12] .…”

Section: Discussionmentioning

confidence: 84%

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Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

Chang¹,

Chang²,

Lin³

et al. 2009

WJG

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Section: Discussionmentioning

confidence: 84%

“…Peng et al [11] documented that the severity of inflammation in cholecystitis with CBD stones did not influence the level of aminotransferases and bilirubin. However, the severity of inflammation was defined as acute attack or not.…”

Section: Discussionmentioning

confidence: 99%

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

Chang¹,

Chang²,

Lin³

et al. 2009

WJG

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“…Peng et al [64] investigated patients presenting with cholecystitis and found that there was a 33% chance of concomitant CBD stones with a gGT higher than 90 U/l and less than a 2% chance with a gGT lower than 90 U/l. In 1,002 patients undergoing laparoscopic cholecystectomy for any reason, Yang et al [65] observed that abnormal gGT values had a sensitivity of 84.1%, a specificity of 72%, a positive predictive value of 22.4%, and a negative predictive value of 97.9% for detecting concomitant CBD stones before surgery.…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

et al. 2009

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Background Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks.Conclusion From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.Keywords Acute biliary pancreatitis Á Cholecystectomy Á Endoscopic sphincterotomy Á ERCP Á Recurrent Acute biliary or gallstone pancreatitis (ABP) is an inflammatory condition of the pancreas induced by gallstones [1]. The initial treatment of ABP can be either conservative or interventional. The coexistence of cholangitis is an accepted indication for the performance of endoscopic retrograde cholangiopancreaticography (ERCP). However, whether this procedure is performed for patients with ABP depends on local expertise and guidelines, as is the decision to perform an endoscopic sphincterotomy (ES) [2][3][4][5].After patients have recovered from their first attack of ABP, most guidelines advocate a cholecystectomy to prevent a recurrent attack or other gallstone-related disorders such as symptomatic choledocholithiasis, cholecystitis, gallstone ileus, jaundice, and cholangitis [2][3][4][5]. ''Recurrent'' symptomatic choledocholithiasis after an initial attack of ABP may be preexisting common bile duct (CBD) stones not detected at the time of the primo episode or stones that migrated from the gallbladder into the CBD after initial stone clearance. Choledocholithiasis also may have developed newly within the bile duct after cholecystectomy.

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“…As a result, the diagnosis of choledocholithiasis by ultrasound and other conventional methods is not particularly reliable. 4,5 Endoscopic retrograde cholangiopancreatography (ERCP) has the highest accuracy in diagnosis of CBD stone. But this approach is invasive, needs expertise, and also expensive.…”

Section: Introductionmentioning

confidence: 99%

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

et al. 2017

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Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

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Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis

Abstract: Selection criteria based on GGT can be used in acute calculous cholecystitis to identify high-risk patients who would benefit most from further imaging to exclude choledocholithiasis.

Cited by 118 publications

References 17 publications

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

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