Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography

Abstract

This EUS study confirms that the CBD dilates significantly after the age of 70 years, but even in the most elderly patients, with an intact gallbladder, the normal CBD does not exceed 7.6 mm, thus a wider CBD warrants further investigation. The single additional factor contributing to dilatation of the CBD was cholecystectomy. A linear regression equation is proposed for the prediction of CBD diameter.

The Relationship between Age, Common Bile Duct Diameter and Diagnostic Probability in Suspected Choledocholithiasis

“…A CT-based study, reporting the strongest correlation between age and CBD size in the literature ( r = 0.974), found mean CBC size for patients over 70 was still less than 6 mm [31] . In contrast, a recent review using endoscopic ultrasound reported CBD size of 7.5 mm in those >70 years of age but also noted that the maximal diameter never exceeded 7.6 mm in patients without previous cholecystectomy [22] .…”

“…An upper CBD size limit of 6 mm has entered the surgical lexicon on the basis of early ultrasonographic studies [17][18][19][20] . This absolute size determination has been questioned however [21] , particularly as multiple factors may impact CBD size, particularly cholecystectomy and age-related physiologic changes [22] . Progressive enlargement of the CBD across the lifespan was initially described by early autopsy series, noting an increase of 0.3-0.4 mm in diameter per decade [23] .…”

“…In many of these reviews, attempts at linear correlation are abandoned in favor of determination of a cutoff age at which CBD size significantly differs from the remainder of the population. This methodology is problematic as it does not fit as easily with the underlying theory of progressive age-related histological CBD changes and because of the potential to reflect the statistical phenomenon of multiple comparisons, particularly as the reported age cut-offs at which CBD size significantly increases have ranged from 40 to 71 years [4,22,26,[28][29][30][31] .…”

Intraductal papillary mucinous neoplasms of the pancreas: radiological predictors of malignant transformation and the introduction of bile duct dilation to current guidelines

“…For the differentiation of IPMN subtypes in BD-or MD-/mixed-type IPMNs, a cut-off value of 5 mm was defined for the MPD, which is in agreement with the current guidelines. 4 All radiological criteria (Table 1) were evaluated retrospectively in consensus by two radiologists (AS, 5 years' experience in pancreas imaging, and MK, 12 years' experience in pancreas imaging), using a standardized checklist including: size, location, presence of a solid component, septum formation, vascular involvement (evaluated according to Klauss et al 14 ), lymphadenopathy (defined as shortaxis diameter of $1 cm 15 ), parenchymal atrophy, common bile duct (CBD) dilation (defined as $8 mm or $1 cm in diameter post cholecystectomy 16,17 ) and MPD diameter. Although the radiologists knew that they were presented images of histologically proven IPMNs, they were blinded for the histological type.…”

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

“…Moreover, the fragmentation of the longitudinal smooth myocyte bands in elderly subjects and use of drugs such as calcium antagonists and nitroglycerine, may reduce contractility and cause hypotonus of the duct [12,14] . Finally, prior cholecystectomy seems to influence CBD diameter since gallbladder physiologically plays a role in accommodation of pressure fluctuation in biliary system which, after surgery, could be transferred to bile duct causing dilatation [11,[15][16][17] . Among non-obstructive etiologies of CBD dilatation, opioids consumption has been described.…”