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2026, Number 2

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Cir Gen 2026; 48 (2)

Predictive value of preoperative gamma-glutamyl transferase and alkaline phosphatase in the diagnosis of residual choledocholithiasis

Muñoz-Flores J, Santiago-González S

Language: Spanish
References: 30
Page: 79-85
PDF size: 606.25 Kb.


ABSTRACT

Introduction: residual choledocholithiasis occurs in at least 2% of cholecystectomized patients, with reports as high as 5 to 12%. Objective: to evaluate the predictive value of preoperative gamma glutamyl transferase and alkaline phosphatase in the diagnosis of residual choledocholithiasis. Material and methods: retrospective cohort study, with 178 patients, over 18 years of age, who underwent cholecystectomy. The statistical analysis was descriptive and inferential (logistic regression, ROC curves, Youden index). Results: the mean age was 43.85 years. 3.93% (n = 7) of patients had residual choledocholithiasis. The identified cut-off points, 91.5 U/l for gamma glutamyl transferase and 106 U/l for alkaline phosphatase, show high sensitivity (100 and 85.7%, respectively) and specificity (94.2 and 75.4%, respectively). Conclusions: preoperative gamma-glutamyl transferase and alkaline phosphatase levels are associated with asymptomatic choledocholithiasis. These enzymes may help identify patients who should undergo intraoperative cholangiography.


REFERENCES

  1. Pinto AV. Coledocolitiasis y colangitis. En: CejudoNT, Guerrero RF, editores. Nuevo tratado de cirugíageneral. Ciudad de México: El Manual Moderno; 2024. p 1316-1323.

  2. Saldaña CD, Jalife MA, Gracida MN, Vega CS, GalindoGF, Cervantes SC. Common bile duct pressure afteropen intraoperative instrumentation in patients withuncomplicated choledocholithiasis. Cir Cir. 2022; 90:18-22.

  3. Xiang L, Li J, Liu D, Yan L, Zeng H, Liu Y. Safety andfeasibility of primary closure following laparoscopiccommon bile duct exploration for treatment ofcholedocholithiasis. World J Surg. 2023; 47: 1023-1030.

  4. Luo T, Huang Y, Wang S, Yang T, Gong J, Zhou B.Laparoscopic common bile duct exploration withprimary closure is preferred for selected elderlyindividuals with choledocholithiasis. Ann GastroenterolSurg. 2023; 7: 772-783.

  5. Zhang A, Shao G, Li Y, Li K, Zhai G, Dang X, et al.Efficacy and safety of laparoscopic common bile ductexploration with primary closure and intraoperativeendoscopic nasobiliary drainage for choledocholithiasiscombined with cholecystolithiasis. Surg Endosc. 2023;37: 1700-1709.

  6. Wu Y, Jing XC, Fu XS. Advances in risk factors forrecurrence of common bile duct stones. Int J Med Sci.2021; 18: 1067-1074.

  7. Guo X, Fan Q, Guo Y, Li X, Hu J, Wang Z, et al. Clinicalstudy on the necessity and feasibility of routine MRCPin patients with cholecystolithiasis before LC. BMCGastroenterol. 2024; 24: 1-8.

  8. Ruiz PJ, García MA, Ruescas GF, Jurado RM, ScortechiniM, Sagredo RM, et al. Differences between residualand primary choledocholithiasis in cholecystectomypatients. Rev Esp Enferm Dig. 2020; 112: 615-619.

  9. Igor KJ, Aristide BG, Noutakdie TJ, Wakheu TL,Georges EA. Obstructive lithiasis of the lower bile ductdiscovered four decades after cholecystectomy and itsmanagement by ideal choledochotomy: a case report.J Med Case Rep. 2023; 17: 316-320.

  10. Mei Y, Chen L, Zeng PF, Peng CJ, Wang J, Li WP, et al.Combination of serum gamma- glutamyltransferaseand alkaline phosphatase in predicting the diagnosisof asymptomatic choledocholithiasis secondary tocholecystolithiasis. World J Clin Cases. 2019; 7: 137-144.

  11. Saleem MI, Mohsin M, Kirmani O, Majid T, Wani K, UlHM, et at. Is intra-operative cholangiography necessaryduring laparoscopic cholecystectomy? A multicentrerural experience from a developing world country.World J Gastroenterol. 2007; 13: 4493-4497.

  12. Hwa CH, Min S, Kook LH, Lee H. Risk factors ofrecurrence following common bile duct explorationfor choledocholithiasis. J Minim Invasive Surg. 2021;24: 43-50.

  13. Zhang JF, Du ZQ, Lu Q, Liu XM, Lv Y, Zhang XF. Riskfactors associated with residual stones in common bileduct via T tube cholangiography after common bileduct exploration. Medicine. 2015; 94: 1-6.

  14. Ding G, Cai W, Qin M. Single- stage vs two- stagemanagement for concomitant gallstones and commonbile duct stones: a prospective randomized trial withlong- term follow- up. J Gastrointest Surg. 2014; 18:947-951.

  15. Jiang X, Yang G, Wang K, Bi W, Shang D, ZhangG. Clinical efficacy analysis of the combination ofthe laparoscope and preoperative or intraoperativeduodenoscope in the treatment of cholecystolithiasiswith choledocholithiasis: a retrospective study. JLaparoendosc Adv Surg Tech A. 2019; 29: 1539-1543.

  16. Pierce RA, Jonnalagadda S, Spitler JA, Tessier DJ, Liaw JM,Lall SC, et al. Incidence of residual choledocholithiasisdetected by intraoperative cholangiography at the timeof laparoscopic cholecystectomy in patients havingundergone preoperative ERCP. Surg Endosc. 2008;22: 2365-2372.

  17. Lu Z, Zhao H. Preferable timing of intraductalultrasonography during endoscopic retrogradecholangiopancreatography lithotomy: a prospectivecohort study. Front Med (Lausanne). 2022; 9:1042929. doi: 10.3389/fmed.2022.1042929.

  18. Seretis C, Zohdy M, Padgett B, Janardhanan. Routineextensive dissection of the cystic duct duringlaparoscopic cholecystectomy to reduce the risk ofresidual choledocholithiasis: an unnecessary step anda potentially hazardous concept. Prz Gastroenterol.2022; 17: 67-72.

  19. Yin Z, Zhu Y, Li Z, Jiang X, An W, Yin L. Factorsrelated to residual gallbladder calculi formation usingcomputed tomography and magnetic resonanceimaging combined with clinical data. J Int Med Res.

  20. 2020; 48: 1-9.20. Castaños GM, Alvarado PA, Sánchez FP. Choledochusangulation by T-tube. Rev Med Inst Mex Seguro Soc.2020; 58: 622-627.

  21. Ovalle CC, Guajardo ND, Elizondo PR. Performanceof the predictive criteria of the American Societyfor Gastrointestinal Endoscopy in the diagnosis ofcholedocholithiasis at a secondary care public hospitalin the State of Nuevo Leon, Mexico. Rev GastroenterolMex. 2023; 88: 322-332.

  22. Zhu J, Tu S, Yang Z, Fu X, Li Y, Xiao W. Laparoscopiccommon bile duct exploration for elderly patients withcholedocholithiasis: a systematic review and metaanalysis.Surg Endosc. 2020; 34: 1522-1533.

  23. Ak C, Aykut H, Pala E, Sayar S, Tarikci KE, Adali G.Post-ERCP complication analysis of an experiencedcenter. Surg Laparosc Endosc Percutan Tech. 2022;32: 707-713.

  24. Sagami R, Hayasaka K, Ujihara T, Iwaki T, KatsuyamaY, Harada H, et al. Accurate evaluation of residualcommon bile duct stones by endoscopic ultrasound: atwo- step check method for residual stones clearance.Digestion. 2022; 103: 224-231.

  25. Yang JJ, Liu XC, Chen XQ, Zhang QY, Liu TR. Clinicalvalue of DPOC for detecting and removing residualcommon bile duct stones (video). BMC Gastroenterol.2019; 19: 135-142.

  26. Jiang Y, Zhang J, Li W, Li L. Primary closure versusT-tube drainage after laparoscopic common bileduct exploration in patients with non- severe acutecholangitis. Updates Surg. 2022; 74: 899-906.

  27. Liu B, FU L, Lu T, Zhang G, Dong X, Zhao Q, et al.Comparison of efficacy and safety of laparoscopicholmium laser lithotripsy and laparoscopic bile ductexploration for bile duct stones: a systematic reviewand meta- analysis. World J Surg. 2023; 47: 1809-1820.

  28. Yurgaky-Sarmiento J, Otero-Regino W, Gómez-ZuletaM. Elevated transaminases: a new tool for the diagnosisof choledocholithiasis. A case control study. Rev ColGastroenterol. 2020; 35: 319-328.

  29. Kadah A, Khoury T, Mahamid M, Assy N, Sbeit W.Predicting common bile duct stones by non-invasiveparameters. Hepatobiliary Pancreat Dis Int. 2020; 19:266-270.

  30. Costa PHP, Sousa JHB, Lima IT, Noronha MAN, AranhaGL, Arienzo VP, et al. The use of serum alkalinephosphatase as a choledocholithiasis marker to mitigatethe cost of magnetic resonance cholangiography.Einstein (Sao Paulo). 2023; 21: eAO0204.




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