Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria

Tatiana Ramírez-Peña, Rómulo Darío Vargas-Rubio, Carlos Ernesto Lombo, Luis Miguel Rodríguez-Hortua, Oscar Mauricio Muñoz-Velandia

Producción: Contribución a una revistaArtículorevisión exhaustiva

Resumen

Introduction: Dynamic changes in liver function tests have been proposed to correctly reclassify the risk of choledocholithiasis; however, information is scarce and insufficient to recommend its use.
Methods: Retrospective cohort of patients undergoing endoscopic retrograde
cholangiopancreatography (ERCP) due to moderate and high risk of choledocholithiasis according to the 2019 American Society of Gastrointestinal Endoscopy (ASGE) guidelines.
We evaluated whether significant changes in liver function tests (bilirubin, transaminases, or alkaline phosphatase), defined as an increase or a reduction ⩾30 or ⩾50% between two measurements taken with a difference of 24–72h can correctly reclassify the risk of choledocholithiasis beyond the ASGE guidelines. The net reclassification index (NRI) was calculated for patients with and without choledocholithiasis.
Results: Among 1175 patients who underwent ERCP, 170 patients were included in the analysis (59.4% women, median 59.5years). Among patients without a diagnosis of choledocholithiasis, the number of patients correctly reclassified by transaminases was slightly higher than those incorrectly reclassified (NRI=0.24 for aspartate amino transaminase and 0.20 for alanine amino transaminase). However, among patients with a diagnosis of choledocholithiasis, it led to incorrect reclassification in a greater number of cases (NRI=−0.21 and −0.14, respectively). The benefits of reclassification were minimal for bilirubin
and alkaline phosphatase, or for value changes >50%. A subgroup analysis showed similar findings in patients without a history of cholecystectomy and in those with normal bile duct.
Conclusion: Dynamic changes in liver function tests do not improve choledocholithiasis risk classification beyond the 2019 ASGE criteria. New criteria should continue to be sought to optimize risk stratification.
Idioma originalInglés
Páginas (desde-hasta)1-9
Número de páginas9
PublicaciónTherapeutic Advances in Gastrointestinal Endoscopy
Volumen16
DOI
EstadoPublicada - 30 sep. 2023

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