Rapid diagnosis of choledocholithiasis using biochemical tests in patientsundergoing laparoscopic cholecystectomy

Backgronnd/Aims: The present study was designed to identify the biochemical tests which could detect the presence of common bile duct stones in patien ts with symptomatic gallstones, without; other invasive investigations. The usefulness of biochemical tests may reduce the necessity of endoscopic ret rograde cholangiopancreatography prior to laparoscopic cholecystectomy. Methodology: 3000 patients with symptomatic laparoscopic cholecystectomy sc heduled for laparoscopic cholesystectomy were included in the study. 458 pa tients (201 men, 257 women; mean age, 51.7 +/- 14.6 yrs) were examined with endoscopic retrograde cholangiopancreatography for suspected common bile d uct stones. The serum tests for liver function, including a measurement of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, gamma -glutamyltransferase and albumin were obtained on admission prior to the ultrasonography, and the endoscopic retrograde cholangiopancreatography. Results: The six significant factors, including alkaline phosphatase, direc t bilirubin, total bilirubin, aspartate aminotransferase,. alanine aminotra nsferase and gamma -glutamyltransferase were identified by the univariate a nalysis and the multivariate logistic regression analysis which identified alkaline phosphatase and gamma -glutamyltransferase, as the two significant independent factors. A statistical model was developed with a formula of 1 / 1+e(-z) A curve of receiver operating characteristics was constructed to identify an alkaline phosphatase level greater than 300 U/L or a gamma -gl utamyltransferase level greater than 420 mU/mL which would have both. highe r sensitivity and specificity. Conclusions: Biochemical tests can be a significant aid to the clinician's decision-making when predicting the presence of common bile duct stones in patients with gallstones.