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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

12 Issues per year


IMPACT FACTOR 2016: 3.432

CiteScore 2016: 2.21

SCImago Journal Rank (SJR) 2016: 1.000
Source Normalized Impact per Paper (SNIP) 2016: 1.112

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1437-4331
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Volume 44, Issue 12 (Dec 2006)

Issues

Stone or stricture as a cause of extrahepatic cholestasis – do liver function tests predict the diagnosis?

Jukka Karvonen / Veli Kairisto / Juha M. Grönroos
  • Department of Surgery, University of Turku, Turku, Finland and Department of Emergency, University of Turku, Turku, Finland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2006-12-13 | DOI: https://doi.org/10.1515/CCLM.2006.261

Abstract

Background: Cholestasis, roughly divided into intrahepatic and extrahepatic forms, is a clinical challenge. Extrahepatic cholestasis, characterized by dilated bile ducts, is caused by either a bile duct stone or stricture, with stricture most often related to a malignancy. The aim of the present study was to analyze the value of common liver function tests in separating patients with malignant bile duct strictures from those with stones.

Methods: All consecutive patients admitted for endoscopic retrograde cholangiopancreatography (ERCP) were included in the study population if a bile duct stricture related to a malignancy was found by ERCP (n=103) or if a bile duct stone was successfully extracted during ERCP, thus confirming the diagnosis of a stone (n=109). Plasma alkaline phosphatase, γ-glutamyltransferase, alanine aminotransferase and bilirubin values were determined in the morning before ERCP.

Results: Plasma bilirubin (p<0.001), alkaline phosphatase (p<0.001) and alanine aminotransferase (p=0.040) levels were significantly higher in patients with malignant bile duct strictures than in those with bile duct stones. In addition, γ-glutamyltransferase levels seemed to be higher in patients with malignant strictures than in those with stones, although the difference did not reach statistical significance (p=0.053). In receiver operating characteristic analyses, bilirubin proved to be the best laboratory test in differentiating patients (p=0.001 vs. alkaline phosphatase, p<0.001 vs. alanine aminotransferase and p<0.001 vs. γ-glutamyltransferase). With a plasma bilirubin cutoff value of 145μmol/L, four out of five patients were categorized correctly.

Conclusions: Plasma bilirubin seems to be the best liver function test in distinguishing patients with malignant bile duct strictures from those with bile duct stones. This routine test should receive more attention in clinical decision-making than has previously been given.

Clin Chem Lab Med 2006;44:1453–6.

Keywords: bile duct stone; bile duct stricture; bilirubin; cholestasis; jaundice; liver function test

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About the article

Corresponding author: Dr. Jukka Karvonen, Loimaa District Hospital, Seppälänkatu 15-17, P.O. Box 17, 32201 Loimaa, Finland Phone: +358-2-76130, Fax: +358-2-7613370,


Received: 2006-07-10

Accepted: 2006-09-10

Published Online: 2006-12-13

Published in Print: 2006-12-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2006.261.

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©2006 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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