[Predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis].
BACKGROUND
To assess the role of alkaline phosphatase (AP), gamil-glutamyltransferase (gammaGT) and abdominal ultrasound (US) as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis.


METHODS
Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 +/- 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC) or pre-operative endoscopic retrograde cholangiography (ERCP), which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients sustaining or not such alteration in cholangiography. Student t, Fisher and chi square tests were used for statistical analysis, considering p<0.05 as significant. Positive (PPV) and negative predictor values (NPV) were calculated for each variable.


RESULTS
Upon admission, 15 (37%) patients sustained biliary tract dilatation and 5 (12%) choledocholithiasis at the US. Forty eight hours before the operation, 34 (85%) patients had altered levels of gGT and 16 (40%) of AP. Pre-operative US showed biliary tract dilatation in nine patients and choledocholithiasis in three. ERCP was performed in 15 (37%) cases. Higher PPV (55%) was attributed to pre-operative US, which had also a NPV of 96%.


CONCLUSIONS
The best predictor of choledocholithiasis in patients sustaining mild acute pancreatitis was the biliary tract dilatation in pre-operative US.
Parreira
José Gustavo
JG
Serviço de Emergência, Grupo de Vias Biliares e Pâncreas, Departamento de Cirurgia, Faculdade de Ciências Médicas de Santa Casa, São Paulo.
Rego
Ronaldo Elias Carnut
RE
Campos
Tercio de
Td
Moreno
Cristina Hachul
CH
Pacheco
Adhemar Monteiro
AM
Rasslan
Samir
S
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D004796:Clinical Enzyme Tests / Q000592:standards*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood*
D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase