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. 2023 Aug 11:21:eAO0204.
doi: 10.31744/einstein_journal/2023AO0204. eCollection 2023.

The use of serum alkaline phosphatase as a choledocholithiasis marker to mitigate the cost of magnetic resonance cholangiography

Pedro Henrique Peixoto Costa  1 , Jorge Henrique Bento de Sousa  1 , Ian Torres de Lima  1 , Marcos Antonio Neves Noronha  1 , Gabriel Lunardi Aranha  1 , Vitor Pelogi Arienzo  1 , Phellipe Fabbrini Santos Lucas  1 , Milton Steinman  1 , Francisco Tustumi  1
Affiliations

The use of serum alkaline phosphatase as a choledocholithiasis marker to mitigate the cost of magnetic resonance cholangiography

Pedro Henrique Peixoto Costa et al. Einstein (Sao Paulo). .

Abstract

Objective: To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs.

Methods: Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed.

Results: A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model.

Conclusion: Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonance-related heathcare costs.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. The ROC curve for the final model with the variables age and alkaline phosphatase, for the outcome choledocholithiasis
None
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