Predictors of persistent common bile duct stones in mild acute biliary pancreatitis; the role of liver enzyme and dilated CBD on ultrasound

Abstract

Background: Abnormal liver enzyme tests (LET) are frequent in acute biliary pancreatitis (ABP), and not always related to persistent common bile duct stones (CBDS). The aim of our study was to determine whether LET on admission, value variations at 24 h and dilated common bile duct (CBD) on ultrasound (US) are appropriate predictors of CBDS in mild ABP. Methods: Data were analysed from our prospective database of 56 consecutive patients diagnosed of mild ABP; of whom 14(25%) had persistent CBDS confirmed by endoscopic retrograde cholangio-pancreatography. LET; alanin aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TB) on admission and at 24 h were evaluated. Higher LET values were considered: TB>1.2mg/dl, AST>75U/l, ALT>75U/l. Abdominal US was performed. Predictive accuracy of the variables was measured using area-under-the-receiver-operating characteristic curve (AUC) analysis. Results: Neither abnormal LET on admission or its raised values at 24h showed accuracy in predicting CBDS (AUC values under 0.5), nor did the association of the 3 abnormal LET (AUC=0.66; 0.51-0.82). However, dilated CBD on US showed good accuracy for predicting CBDS (AUC=0.75; 0.58-0.91). Conclusion: A dilated CBD on US seems to be superior than abnormal LET in predicting CBDS in mild ABP, it could help to guide decisions making in the emergency setting of mild ABP, on selection of patients who will benefit from other specific imaging techniques.