title: Prevalence of normal liver tests in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Abnormal liver chemistry tests are a hallmark of common bile duct (CBD) stones. There is little information, however, on the prevalence of and predictors for normal liver chemistry tests in such patients.
  
  
  METHODS
  Over an 11-year period, all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at our Center were prospectively identified. Patients in this study were those with CBD stones found at ERCP and where the indication for ERCP was CBD stones seen on imaging studies or when CBD stones were highly suspected based upon clinical presentation and radiographic and laboratory findings. Liver chemistry tests were recorded from those taken at the time of initial presentation as well as the time closest to ERCP.
  
  
  RESULTS
  Of a total of 5,133 patients undergoing ERCP during the study period, the indication was suspicion for CBD stones or for radiographically identified CBD stones in 476 and 593, respectively, with 115 patients having both indications. Of these 1184 patients, 765 had CBD stones of whom 541 had liver tests. Of these 541, 29 patients (5.4%) were found to consistently have normal liver chemistry tests. Multivariate analysis identified two factors predictive of normal liver tests including age >55 years and the presence of abdominal pain.
  
  
  CONCLUSIONS
  Although rare, liver tests can be normal in patients with CBD stones. Patients most likely to have normal liver tests included older patients and those with abdominal pain.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Ala., USA.
authors.forename: Charles Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Hwasoon
authors.initials: H
authors.lastname: Kim
authors.forename: Jessica
authors.initials: J
authors.lastname: Trevino
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.forename: Klaus
authors.initials: K
authors.lastname: Monkemuller
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D015999:Multivariate Analysis; D015995:Prevalence