Correlation Between Elevated Biliary Biomarkers and the Presence of Choledocholithiasis: A Diagnostic Study Using ERCP as the Gold Standard

Abstract

Background: Common bile duct (CBD) stones are a frequent cause of biliary obstruction and can lead to serious complications if left undiagnosed or untreated. Several laboratory markers are commonly used to predict their presence, most notably serum bilirubin and gamma-glutamyl transferase (GGT), both of which tend to rise in the setting of biliary obstruction.

Objective: To evaluate the diagnostic value of serum bilirubin and GGT, individually and in combination, for predicting CBD stones in patients in Northwest Syria.

Methods: This prospective cohort study enrolled patients with suspected CBD stones who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Idlib University Hospital. Serum bilirubin and GGT levels were measured prior to the procedure, and ERCP served as the gold standard for diagnosis. Diagnostic performance was assessed by calculating sensitivity, specificity, positive and negative predictive values, and overall accuracy.

Results: Elevated levels of both bilirubin and GGT were significantly associated with the presence of CBD stones. Each marker demonstrated acceptable diagnostic performance when used alone; however, combining the two yielded higher diagnostic accuracy than either marker individually.

Conclusion: The combination of serum bilirubin and GGT appears to offer a more reliable diagnostic tool for identifying patients who would benefit from ERCP. This approach may prove particularly valuable in resource-limited settings such as Northwest Syria.