Total Bilirubin Is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis
Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify
an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through
2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7
mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones
(P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.
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Document Type: Research Article
From the Departments of Surgery and
David Geffen School of Medicine at UCLA, Los Angeles, California; and the
Emergency Medicine, Harbor–UCLA Medical Center, Los Angeles, California, Los Angeles Biomedical Institute at Harbor–UCLA Medical Center, Los Angeles, California
From the Departments of Surgery and, Los Angeles Biomedical Institute at Harbor–UCLA Medical Center, Los Angeles, California
Publication date: October 1, 2008
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