Aims: To evaluate the importance of elevated gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) as predictor factors for choledocholithiasis in non-jaundiced symptomatic gallstone disease.
Methods: This study was carried out in the Department of General Surgery, Zagazig University Hospitals in the period between February 2016 and February 2017. This study was carried out upon 20 patients diagnosed as symptomatic cholecystitis and met the inclusion criteria i.e., elevated GGT and/or ALP levels with normal bilirubin level and normal common bile duct (CBD) by ultrasonography.
Results: We found that 20 diagnosed cases of symptomatic gallstone disease in the study and they were predominantly females (80%). In preoperative liver function tests, serum bilirubin was normal and ranged from 0.1–1 mg/dl. All cases had GGT level above 60 IU/L and ranged from 82–609 IU/L with mean standard deviation was (mean±SD: 298.3±184.08 IU/L). ALP level ranged from 57–520 IU/L with mean standard deviation was (mean±SD: 210.9±132.82 IU/L) and 30% of these cases had normal level (= 130 IU/L). Magnetic resonance cholangiopancreatography (MRCP) was done for all the cases of the study. 85% of the cases were normal and 15% of the cases were narrow. Statistically, there was highly significant difference decreasing in GGT and ALP levels among postoperative (p < 0.001).
Conclusion: Gamma-glutamyltransferase (GGT) and alkaline phosphatase are sensitive but not specific to choledocholithiasis because of their multiple sources. The value of their estimation preoperatively is that their elevation increase the suspicious of CBD stone or pathology. Their elevation provokes the surgeon to assess the state of CBD by more accurate diagnostic tool as MRCP. Most of the cases (85%) with elevated GGT and/or ALP but with normal bilirubin and ultrasound findings of CBD had no stones at CBD at time of their evaluation. But the small sector (15%) had pathology indicated intervention by endoscopic retrograde cholangiopancreatography (ERCP) and if neglected before laparoscopic cholecystec-tomy, there would be morbidity on the patient.