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Choledocholithiasis Can Present with Marked Transaminases Elevation: Systematic Review and Meta-Analysis

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Abstract

Background

Extreme transaminase elevation > 1000 international units per liter (IU/L) is typically caused by hepatocellular injury due to ischemia, drugs, or viral infection. Acute choledocholithiasis can also present with marked transaminase elevation mimicking severe hepatocellular injury, contrary to the presumed cholestatic pattern.

Methods

We searched PubMed/Medline, EMBASE, Cochrane Library, and Google Scholar for studies reporting the proportion of marked elevation of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 1000 IU/L in patients with common bile duct (CBD) stones. A proportion meta-analysis with a corresponding 95% confidence interval (CI) was used to pool the proportion of patients with extreme transaminase elevation. I2 was used to examine heterogeneity. We used CMA software utilizing a random effect model for statistical analysis.

Results

Three studies (n = 1328 patients) were included in our analysis. The reported frequency of ALT or AST > 1000 IU/L in choledocholithiasis patients ranged between 6 and 9.6%, with pooled frequency of 7.8% (95% CI 5.5–10.8%, I2 61%). The frequency of patients with ALT or AST > 500 IU/L was higher, ranging between 28 and 47%, with pooled frequency of 33.1% (95% CI 25.3–42%, I2 88%).

Conclusion

This is the first meta-analysis to study prevalence of severe hepatocellular injury in patients with CBD stones. Results revealed that approximately one-third of patients with choledocholithiasis present with ALT or AST > 500 IU/L. Furthermore, levels > 1000 IU/L are not uncommon. An elaborate work-up for alternative etiologies of severe transaminase elevation is likely unwarranted in cases with clear evidence of choledocholithiasis.

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Funding

This research received no funding or financial arrangement.

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Authors and Affiliations

  1. Division of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA

    Mouhand F. H. Mohamed, Neha Wadhavkar & Daniel Marino

  2. Department of Medicine, SBH Health System, New York, NY, USA

    Khaled Elfert

  3. Division of Gastroenterology, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Kanhai Farrakhan & Ronan Farrell

  4. Gastroenterology and Hepatology Department, Indiana University, Indianapolis, IN, USA

    Azizullah Beran

  5. Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA

    Mohamed A. Abdallah

  6. Division of Digestive Disease, Emory University, Atlanta, GA, USA

    Abubaker Abdalla

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  1. Mouhand F. H. Mohamed
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Contributions

Conception, design: MFM. Writing the initial draft: MFM, NW, KF. Study search, review, and selection: MFM, KE, and MA. Data collection and synthesis: MFM, KE. Statistical analysis and generation of figures: MFM. Manuscript submission and handling: NW. All authors: interpretation of data, drafting, and critical revision of the article. All authors approved the final version for publication.

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Correspondence to Mouhand F. H. Mohamed.

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Mohamed, M.F.H., Elfert, K., Wadhavkar, N. et al. Choledocholithiasis Can Present with Marked Transaminases Elevation: Systematic Review and Meta-Analysis. Dig Dis Sci 68, 3428–3435 (2023). https://doi.org/10.1007/s10620-023-07981-7

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