The Clinical Significance of Common Bile-Duct Dilatation in Patients without Biliary Symptoms or Causative Lesions on Ultrasonography

Kim, J.-E.; Lee, J. K.; Lee, K. T.; Park, Dong Il; Hyun, Jae Chun; Paik, S.W.; Rhee, Jong Chul; Choi, Kyong Woo; Lim, Jeung-Keun

doi:10.1055/s-2001-15088

Cited by 34 publications

(25 citation statements)

References 6 publications

(6 reference statements)

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“…A diameter greater than 7 mm defines CBD dilatation, which may indicate biliary pathology [1][2][3][4] and generally warrants further investigation. Since its inception in the early 1970s, endoscopic retrograde cholangiopancreatography (ERCP) had been regarded as the gold standard for evaluation of the CBD and the biliary tree [5,6].…”

Section: Introductionmentioning

confidence: 98%

EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

et al. 2007

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The finding of common bile duct (CBD) dilatation on abdominal imaging frequently results in additional testing. It has been our impression that endoscopic ultrasound (EUS) evaluation of a dilated CBD is a low-yield examination in the setting of normal serum liver enzymes. We therefore sought to evaluate the EUS yield in evaluating CBD dilatation in patients with normal as compared to elevated serum liver enzymes. A retrospective review was performed to identify patients referred for EUS evaluation of a dilated CBD in the absence of obvious pathology on prior imaging. Charts were reviewed for patient symptoms, presence of elevated serum liver enzymes, imaging studies before EUS, and EUS findings. Exclusion criteria included clinical jaundice, known biliary stricture, mass lesion or stone, and previously sphincterotomy and/or stent placement. Forty-seven patients were identified: 32 with normal and 15 with elevated serum liver enzymes. There was no difference in mean CBD diameter between these two groups (8.51 vs. 8.79 mm, p=0.854). Of the entire group, 15 patients had undergone prior magnetic resonance cholangiopancreatography (MRCP); an additional 7 patients had undergone prior endoscopic retrograde cholangiopancreatography (ERCP). EUS findings to explain CBD dilatation were found more commonly in patients with elevated compared with normal serum liver enzymes (53% vs. 6%, p=0.001). Periampullary diverticula and choledocholithiasis were the most common findings; of 32 patients with normal serum liver enzymes, one periampullary diverticulum and one CBD stone were found, respectively. The CBD stone had been missed by prior MRCP examination. Of 15 patients with elevated serum liver enzymes, there were 3 cases of choledocholithiasis, 4 periampullary diverticula, and 1 ampullary tumor. EUS should be the test of choice for further evaluation of CBD dilatation when index imaging is normal. Although the EUS yield is low in cases of biliary dilatation in the setting of normal serum liver enzymes, its preferential use would potentially avoid unnecessary MRCP and ERCP.

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Section: Introductionmentioning

confidence: 98%

EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

et al. 2007

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“…[8][9][10] The etiology of a patient's dilated duct can be explored with further investigation via MRCP, EUS or ERCP. 11,12 In the majority of cases, the etiology for the dilated duct(s) is benign but clinicians are always concerned for an underlying neoplasm. 12 Agarwal et al reported that 11.5% of patients who were found to have a dilated pancreatic duct on abdominal imaging had a pancreatic adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

jig

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Background:Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts. Objective: Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts. Design: Retrospective database analysis. Setting: Tertiary-care university hospital. Patients: Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included. Interventions: An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed. Main Outcome Measurements: The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD. Results: A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS. Limitations: A retrospective study with a small number of patients. Conclusion: Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.

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“…A study in 2001 by Kim et al [42] evaluated patients with asymptomatic biliary dilatation initially identified on US with ERCP, repeat US, or CT. It is unclear, however, what led to the initial imaging that identified the biliary dilatation, and the degree of dilatation is not specified for the entire population but was rather reported as means for subgroups of those patients in whom a plausible causative lesion was identified or no lesion identified (13.2±3.9 mm and 10.7±2.0 mm respectively).…”

Section: Investigation and Managementmentioning

confidence: 99%

What Should Be Done with a Dilated Bile Duct?

Holm

Gerke

2010

Curr Gastroenterol Rep

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Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigations in patients with incidentally identified modest ductal dilatation without symptoms or laboratory abnormalities. Additional investigations are more likely to identify clinically relevant findings in patients with more pronounced dilatation. EUS is highly accurate, low-invasive, and useful in this setting, whereas ERC should be reserved for cases likely to require therapeutic intervention.

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The Clinical Significance of Common Bile-Duct Dilatation in Patients without Biliary Symptoms or Causative Lesions on Ultrasonography

Cited by 34 publications

References 6 publications

EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

What Should Be Done with a Dilated Bile Duct?

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