Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures.
OBJECTIVE
Simplified evaluation based on clinical and biochemical variables might predict the degree of hepatic fibrosis in patients with postcholecystectomy bile duct strictures.


METHODS
Prospective cohort study.


METHODS
Tertiary care referral and teaching hospital.


METHODS
Sixty-four patients with postcholecystectomy bile duct strictures undergoing definitive repair. Prospectively collected information included demographics, disease-related characteristics, and serial liver function tests. Hepatic histologic features (fibrosis, cholestasis, portal inflammation, and ductular proliferation) were independently graded by 2 pathologists masked to clinical data using a previously validated scale. Patients were dichotomized into groups based on degree of hepatic fibrosis. Univariate and multivariate analyses were performed.


METHODS
Identification of variables that predict the presence of advanced hepatic fibrosis (grade 2-3).


RESULTS
Thirty-five patients (55%) had early hepatic fibrosis (grade 0-1), and the remaining 29 (45%) had advanced fibrosis (grade 2-3). Univariate analysis demonstrated that duration of biliary obstruction, presence of portal hypertension, basal alanine aminotransferase (ALT) levels, and time to normalization of serum total bilirubin, ALT, and alkaline phosphatase levels after surgical drainage were statistically significantly associated with the presence of advanced hepatic fibrosis. However, multivariate analysis revealed that only duration of biliary obstruction (odds ratio [OR], 1.6048; P =.009), basal ALT levels (OR, 0.9634; P =.02), and time to normalization of ALT levels after surgical drainage (OR, 1.6680; P =.006) were significant predictors of advanced hepatic fibrosis.


CONCLUSIONS
Duration of biliary obstruction, basal ALT level, and time to normalization of ALT level after surgical repair are independent predictors of advanced hepatic fibrosis (grade 2-3) in patients with postcholecystectomy bile duct strictures.
Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital, University of Delhi, New Delhi, India.
Sanjay Singh
SS
Negi
Puja
P
Sakhuja
Veena
V
Malhotra
Adarsh
A
Chaudhary
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003137:Common Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin