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Research Article
Multicenter retrospective cohort study: Using trends in liver function tests to predict spontaneous passage of common bile duct stones in choledocholithiasis
1 General Surgery Registrar, Associate Lecturer, University of Queensland Surgical Division, Redcliffe Hospital Metro North Health, Anzac Ave, Redcliffe, QLD 4020, Australia
2 General Surgery Registrar, Surgical Division, Mackay Base Hospital, 475 Bridge Road, Mackay, QLD 4740, Australia
3 Urology Department, Palmerston North Hospital, 50 Ruahine Street, Roslyn, Palmerston North 4442, New Zealand
4 General Surgery Consultant, Surgical Division, Redcliffe Hospital Metro North Health, Anzac Ave, Redcliffe, QLD 4020, Australia
Address correspondence to:
Bardia Bidarmaghz
Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD 4053,
Australia
Message to Corresponding Author
Article ID: 100102Z04BB2023
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Bidarmaghz B, Sabat N, Sharma A, McGregor H, Wong J. Multicenter retrospective cohort study: Using trends in liver function tests to predict spontaneous passage of common bile duct stones in choledocholithiasis. Int J Hepatobiliary Pancreat Dis 2023;13(1):7–14.ABSTRACT
Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice in patients who are diagnosed with choledocholithiasis, but it carries potentially life-threatening risks and is not readily available in rural hospitals. Due to the lack of access to this service, trend of liver function tests is often used to predict the spontaneous passage of common bile duct (CBD) stone to prevent performing a negative ERCP. The aim of this study is to investigate whether the trend of liver function tests can be used to predict passage of common bile duct stone in patients who have radiological evidence of choledocholithiasis.
Methods: The liver function tests (LFTs) of patients diagnosed with choledocholithiasis at two separate hospitals in New Zealand and Australia were collected at two points retrospectively. The change in LFT values between diagnosis and immediately prior to ERCP was analyzed.
Results: Total of 409 patients were selected with 108 (26%) and 301 (74%) patients from Australia and New Zealand, respectively. Demographic and LFT values were statistically different between the two centers, but the female sex was significantly predominant in both. Cumulative data showed that 37% of patients diagnosed with choledocholithiasis had no stone during the ERCP procedure. Increased age was statistically significant in patients with a persistent stone on ERCP. Importantly, there was no statistical difference between LFT values of patients with persistent gallstones shown on ERCP compared to those who have passed their gallstones spontaneously. Aspartate aminotransferase (AST) was significantly associated with a persistent gallstone (p = 0.041), but its clinical value is questionable.
Conclusion: Decreasing trend in LFTs and their individual components are poor predictors of persistent gallstones in patients diagnosed with choledocholithiasis. Two-thirds of these patients have persistent stones and ERCP remains an important diagnostic and therapeutic modality for patients at significant risk of disease complications.
Keywords: Cholangiopancreatography, Cholangitis, Choledocholithiasis, ERCP, Liver function test, Magnetic resonance
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Acknowledgments
No preregistration exists for the reported studies reported in this article.
Author ContributionsBardia Bidarmaghz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nestor Sabat - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Aditya Sharma - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hugh McGregor - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jason Wong - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Bardia Bidarmaghz et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
