59 - THE ROLE OF PREOPERATIVE MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY/ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE SETTING OF MIDLY ELEVATED LIVER ENZYMES PRIOR TO CHOLECYSTECTOMY

Objectives: The role of cholangiopancreatography prior to cholecystectomy is a subject of debate as elevated liver enzymes (LFTs) may or may not be a result of active choledocholithiasis. The aim of this study is to evaluate the roll of obtaining MRCP/ERCP prior to proceeding with cholecystectomy in patients presenting with mildly elevated LFTs, as defined as total bilirubin of 2-4 mg/dL ( < 5x the upper limit of normal).

Methods: The HCA Healthcare southeast division database was retrospectively queried for patients ages 18-80 undergoing inpatient cholecystectomy with abnormally elevated total bilirubin during years 2014-2021. Patients with a bilirubin > 4mg/dL at any point during admission were excluded. Patient encounters were then queried for performance of MRCP/ERCP. Presence of choledocholithiasis was confirmed via analysis of ERCP reports for presence of choledocholithiasis and stone extraction. A multivariate logistic regression was used with additive and interaction models.

Results: A total of 4,432 patient encounters were included. In the additive model, both ERCP and MRCP were predictive of presence of choledocholithiasis with Odds Ratios (OR) of 3.23 and 1.66 (p < 0.0001), respectively. Mildly elevated total bilirubin was not found to increase odds of choledocholithiasis presence in either the additive model OR 1.2 (p=0.76) or the interaction model OR 1.18 (p=0.2) (Table1).

Conclusion: Mildly elevated bilirubin levels are not a sufficient indication for stone presence when accounting for confirmatory tests like MRCP/ERCP. Routine cholangiopancreatography prior to planned cholecystectomy is not indicated in patients presenting with mildly elevated bilirubin levels.