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

Authors
 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 
Citation
 Medicine, Vol.95(42) : 5176-5176, 2016 
Journal Title
 Medicine 
ISSN
 0025-7974 
Issue Date
2016
MeSH
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*
Keywords
aminotransferase ; choledocholithiasis ; gallstone hepatitis
Abstract
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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DOI
10.1097/MD.0000000000005176
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실)
Yonsei Authors
김자경(Kim, Ja Kyung) ORCID logo https://orcid.org/0000-0001-5025-6846
김재근(Kim, Jae Keun)
김희욱(Kim, Hee Wook)
박준성(Park, Joon Seong) ORCID logo https://orcid.org/0000-0001-8048-9990
이동기(Lee, Dong Ki) ORCID logo https://orcid.org/0000-0002-0048-9112
이세준(Lee, Se Joon)
임범진(Lim, Beom Jin) ORCID logo https://orcid.org/0000-0003-2856-0133
장성일(Jang, Sung Ill) ORCID logo https://orcid.org/0000-0003-4937-6167
허철웅(Huh, Cheal Wung)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152488
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