title: Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy.
abstract: OBJECTIVE
  The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS).
  
  
  METHODS
  All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302,564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS.
  
  
  RESULTS
  A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis.
  
  
  CONCLUSIONS
  Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.
authors.affiliation: Department of Surgery, Central Hospital, Västerås, Sweden. pervidehult@yahoo.se
authors.forename: Per
authors.initials: P
authors.lastname: Videhult
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.forename: Claes
authors.initials: C
authors.lastname: Rudberg
authors.forename: Ib Christian
authors.initials: IC
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002758:Cholangiography; D002763:Cholecystectomy; D002764:Cholecystitis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase; D001663:Bilirubin