Routine testing of liver function after biliary-enteric anastomosis has no clinical relevance

Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim of this study was to investigate whether elevated liver function tests are associated with recurrent episodes of cholangitis.

Thirty-two patients, who received a biliary-enteric anatomosis for benign biliary disease were evaluated. Follow-up consisted of the patient's history, physical examination, determination of liver function tests, ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA.

Median duration of follow-up was 45 months (range: 1-192) and liver function tests were elevated in 22 patients (69%) at some time during follow-up. Dilated intrahepatic ducts were found in 3 of 30 patients (10%), all of whom had elevated liver function tests at follow-up. Delayed passage from the liver was observed using scintigraphy in 10 (31%) of the patients. Seven patients (22%) experienced one episode of cholangitis and none experienced more than one episode. Multivariate analysis showed that male sex was an independent risk factor for elevated liver function tests (odds ratio: 10.9; P < 0.05). For cholangitis, no risk factors could be identified.

It is concluded that elevated liver function tests are relatively common after a biliary-enteric anastomosis for benign biliary tract disease and are not predictive of the occurrence of cholangitis. We, therefore, recommend omitting routine laboratory screening for elevated liver function tests in the follow-up of a biliary-enteric anastomosis.