Total bilirubin trend as a predictor of choledocholithiasis in patients with Gallstones disease.

Background: Many diagnostic parameters represent the presence of a Common bile duct (CBD) stone, either pre-intra or post-operatively. It varies from lab work to imaging modalities. In this study, we aim to look for the trend of total bilirubin level and its relation to the presence of CBD stones in patients with gallstone disease. 

Methods
A retrospective study was conducted at King Saud University Medical City, involving 280 patients admitted through the emergency department; with a picture of gallstones disease associated with high readings of total and direct bilirubin; from 2017 to 2019, the relation of high levels of bilirubin liver enzymes, Gamma-glutamyl Transferase (GGT), Alkaline phosphatase to the presence of CBD stone was established. 

Results 
Out of 280 patients, 96 were male, and 184 were female. Total bilirubin was high in 28 (10%) patients overall, with a higher proportion of patients reporting high total bilirubin among patients with detected CBD stones. First and third total bilirubin measurements recorded a median (IQR) of 19.64 (8.65-39.85), and 15.19 (8.10-29.81), respectively, with a 50% reduction noted among 63 (22.5%) patients of all participants. Moreover, normalization of total bilirubin was reported among 134 (47.9%) patients overall, with normalization reported in more patients with no CBD stones. GGT was found to be the only laboratory test significantly related to choledocholithiasis 

Conclusion 
High levels of bilirubin and alkaline phosphatase were found as predictors of choledocholithiasis, while other laboratory markers were not. Further imagining studies are warranted to diagnose the presence of CBD stones.