Ynag et al evaluated several serum analytes in patients requiring laparoscopic cholecystectomy with and without common bile duct (CBD) stones. These can help to identify those patients who may require additional studies before or during the procedure to locate any stones in the common bile duct. The authors are from Taipei Veterans General Hospital in Taiwan.


Patient selection: cholecystitis with cholelithiasis, without primary bile duct, pancreatic or ampullary disease. The prevalence of CBD stones was 9%.


Laboratory profile:

(1) gamma glutamyl transferase (GGT)

(2) alkaline phosphatase

(3) total bilirubin

(4) alanine aminotransferase (ALT, SGPT)

(5) aspartate aminotransferase (AST, SGOT)


A patient with all 5 tests negative had a very low rate of common bile duct stones (negative predictive value 98%). The sensitivity of one or more abnormal tests was 88%.


A negative GGT had a 98% negative predictive value for CBD stones.


A positive total bilirubin was the most specific (88%) with a positive predictive value of 27%.


The authors recommended doing preoperative ERCP if any one of the 5 tests was positive since ERCP had the highest sensitivity (96%) and specificity (99%). Intraoperative cholangiography would probably be done instead in the US.


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