Author/Authors :
Sotoudehmanesh, Rasoul Digestive Disease Research Institute - Shariati Hospital - Tehran University of Medical Sciences , Nejati, Naimeh Gastroenterologist - Baghyatallah hospital , Farsinejad, Maryam Digestive Disease Research Institute - Shariati Hospital - Tehran University of Medical Sciences , Kolahdoozan, Shadi Digestive Disease Research Institute - Shariati Hospital - Tehran University of Medical Sciences
Abstract :
BACKGROUND
The cause of common bile duct (CBD) dilatation cannot be determined by imaging
modalities in many patients. The aim of this study was to assess the value
of endoscopic ultrasonography (EUS) in detecting the cause of CBD dilatation
in patients in whom ultrasonography could not demonstrate the cause of dilation.
METHODS
Prospectively, 152 consecutive patients who were referred for evaluation of
dilated CBD (diameter ≥7 mm) of undetermined origin by ultrasonography were
included in this study. All the patients underwent EUS. Final diagnoses were
determined by using endoscopic retrograde cholangiopancreatography (ERCP),
EUS-guided fine needle aspiration (FNA), surgical exploration, or follow-up for
at least 10 months. Patients with choledocholithiasis were referred for ERCP
and sphincterotomy, and patients with operable tumors were referred for surgery.
Patients with inoperable tumors underwent biliary stenting with or without
chemoradiotherapy. RESULTS
152 patients (54% female) with dilated CBD were included. Mean (±SD)
age of the patients was 60.4 (±17.3) years. The mean CBD diameter for all
study group in transabdominal ultrasonography and EUS were 11.7 millimeter
and 10.1 millimeter, respectively. Most of the patients with dilated CBD
and abnormal liver function test (LFT) had an important finding in EUS and
follow-up diagnosis including peri-ampullary tumors. Mean diameter of CBD
in patients with and without abnormal LFT were 10.5 IU/L and 12.1 IU/L,
respectively. Final diagnoses included choledocholithiasis in 32 (21.1%),
passed CBD stone in 35 (23%), opium-induced CBD dilation in 14 (9.2%),
post-cholecystectomy states in 20 (13.1%), ampullary adenoma/carcinoma in
15 (15.8%), cholangiocarcinoma in 14 (9.2%), and pancreatic head cancer in
9 (5.9%) patients. Sensitivity, specificity, positive predictive value, negative
predictive value and accuracy of EUS for patients with abnormal EUS were
89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively.
CONCLUSION
After diagnosis of CBD dilation by transabdominal ultrasonography, EUS
may be a reasonable choice for determining the etiology of dilated CBD and
tumor staging.
Keywords :
Ampulla of Vater , Common bile duct , Endosonography , Diagnosis
