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Sanjay Singh Negi, MCh; Puja Sakhuja, MD; Veena Malhotra, MD; Adarsh Chaudhary, MS

Arch Surg. 2004;139:299-303.

Hypothesis  Simplified evaluation based on clinical and biochemical variables might predict the degree of hepatic fibrosis in patients with postcholecystectomy bile duct strictures.

Design  Prospective cohort study.

Setting  Tertiary care referral and teaching hospital.

Patients  Sixty-four patients with postcholecystectomy bile duct strictures undergoing definitive repair. Prospectively collected information included demographics, disease-related characteristics, and serial liver function tests. Hepatic histologic features (fibrosis, cholestasis, portal inflammation, and ductular proliferation) were independently graded by 2 pathologists masked to clinical data using a previously validated scale. Patients were dichotomized into groups based on degree of hepatic fibrosis. Univariate and multivariate analyses were performed.

Main Outcome Measure  Identification of variables that predict the presence of advanced hepatic fibrosis (grade 2-3).

Results  Thirty-five patients (55%) had early hepatic fibrosis (grade 0-1), and the remaining 29 (45%) had advanced fibrosis (grade 2-3). Univariate analysis demonstrated that duration of biliary obstruction, presence of portal hypertension, basal alanine aminotransferase (ALT) levels, and time to normalization of serum total bilirubin, ALT, and alkaline phosphatase levels after surgical drainage were statistically significantly associated with the presence of advanced hepatic fibrosis. However, multivariate analysis revealed that only duration of biliary obstruction (odds ratio [OR], 1.6048; P = .009), basal ALT levels (OR, 0.9634; P = .02), and time to normalization of ALT levels after surgical drainage (OR, 1.6680; P = .006) were significant predictors of advanced hepatic fibrosis.

Conclusion  Duration of biliary obstruction, basal ALT level, and time to normalization of ALT level after surgical repair are independent predictors of advanced hepatic fibrosis (grade 2-3) in patients with postcholecystectomy bile duct strictures.

From the Department of Gastrointestinal Surgery (Messrs Negi and Chaudhary) and Pathology (Drs Sakhuja and Malhotra), Gobind Ballabh Pant Hospital, University of Delhi, New Delhi, India.