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Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis: Prospective comparative study

 Cheal Wung Huh  ;  Sung Ill Jang  ;  Beom Jin Lim  ;  Hee Wook Kim  ;  Jae Keun Kim  ;  Jun Sung Park  ;  Ja Kyung Kim  ;  Se Joon Lee  ;  Dong Ki Lee 
 MEDICINE, Vol.95(42) : 5176, 2016 
Journal Title
Issue Date
Aged ; Biomarkers/blood ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy, Laparoscopic/methods* ; Choledocholithiasis/diagnosis* ; Choledocholithiasis/enzymology ; Choledocholithiasis/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Transaminases/blood*
aminotransferase ; choledocholithiasis ; gallstone hepatitis
Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400?IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Kim, Jae Keun(김재근)
Kim, Hee Wook(김희욱)
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Lee, Se Joon(이세준) ORCID logo https://orcid.org/0000-0002-2695-2670
Lim, Beom Jin(임범진) ORCID logo https://orcid.org/0000-0003-2856-0133
Jang, Sung Ill(장성일) ORCID logo https://orcid.org/0000-0003-4937-6167
Huh, Cheal Wung(허철웅)
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