Dilated common bile duct unexplained on transabdominal ultrasonography; the role of endoscopic ultrasonography and predictors of malignancy
Researcher Bulletin of Medical Sciences,
Vol. 22 No. 1 (2017),
AbstractBackground: The aim of the this prospective study was to evaluate the endoscopic ultrasonography (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom ultrasonography(US) could not indicate the cause of dilation.
Methods: Seventy patients with the search criteria of unexplained dilated CBD (diameter > 7 mm) were examined by EUS. All patients (except 4 patients with pancreatic mass) were further evaluated by ERCP.
Results: The following diagnoses were made by EUS and ERCP: choledocholithiasis in 45, pancreato-biliary malignancy (PBM) in 17, papillary stenosis in 5, and no finding in 3 cases. We found that the majority of patients (95.7%) had findings on EUS to explain the etiology of their dilated CBD. The prevalence of pathology is lower (76.9%) in patients with normal liver function tests (LFTs).The yield of EUS is higher (100%) when elevated liver enzymes. Lower hemoglobin levels, larger diameter of CBD and pancreatic duct (PD) and ESR greater than 30 mm/h were independent risk factors for PBM, whereas, patients with previous cholecystectomy, normal LFTs and abdominal pain were less likely to have this diagnosis.
Conclusion: the majority of patients referred for EUS for dilated CBD will have an etiology discovered
Therefore, EUS should be the first diagnostic strategy for dilated CBD of unexplained origin, even in patients with normal LFTs. In patients with dilated CBD accompanied by anemia, abnormal LFTs and ESR or dilated PD, malignancy should be considered.
- Endoscopic ultrasonography
- Dilated CBD
- Pancreato-biliary malignancy.
How to Cite
Levin DC, et al. Recent trends in utilization rates of abdominal imaging: the relative roles of radiologists and nonradiologist physicians. J Am CollRadiol. 2008; 5: 744-7.
Bowie JD. What is the upper limit of normal for the common bile duct on ultrasound: how much do you want it to be? Am J Gastroenterol.2000; 95:897-900.
Parulekar SG. Ultrasound evaluation of common bile duct size. Radiology. 1979; 133:703-7.
Laing FC, Jeffrey RB, Wing VW, et al. Biliary dilatation: defining the level and cause by real time US. Radiology. 1986;160:39–42.
Cronan JJ. US diagnosis of choledocholithiasis: a reappraisal. Radiology. 1986;161:133–4.
Stot MA, Farrands PA, Guyer PB, et al. Ultrasound of the common bile duct in patients undergoing cholesystectomy. J Clin Ultrasound. 1991;19:73–6.
Adler DG, Baron TH, Davila RE, et al.: ASGE guideline: the role of ERCP in diseases of the biliary tract and pancreas. GastrointestEndosc. 2005, 62:1–8.
Amouyal P, Amouyal G, Mompoint G, et al. Endosonography: promising method for diagnosis of extrahepatic cholestasis. Lancet. 1989;2:1195–8.
Dancygier H, Nattermann C. The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice. Endoscopy. 1994;26:800–2.
Sugiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography. GastrointestEndosc. 1997;45:143–6.
Dancygier H, Nattermann C. The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice. Endoscopy.1994;26:800–2.
Adrian N , Henning G. What Should Be Done with a Dilated Bile Duct?Curr Gastroenterol Rep. 2010; 12:150–156
Malik S, Kaushik N, Khalid A, et al. EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes. Dig Dis Sci. 2007; 52:508-12.
Vernon C , Jason C, Jerry E, et al.Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?J IntervGastroenterol. 2012; 2:4, 168-171.
Savio C , Neil G, Shailender S , et al. Pancreato-Biliary Malignancy Diagnosed by Endoscopic Ultrasonography in Absence of a Mass Lesion on Transabdominal Imaging: Prevalence and Predictors.Dig Dis Sci 2011; 56:1912–1916
Yildiran S, Gülay T, and Burhan S. Endoscopic Ultrasonography in the Evaluation of Dilated Common Bile Duct. J ClinGastroenterol. 2001;33(4):302–305.
Kim JE, Lee JK, Lee KT, et al.: The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography. Endoscopy. 2001,33:495–500.
- Abstract Viewed: 0 times
- PDF Downloaded: 0 times