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Role of endoscopic ultrasound in evaluation of unexplained common bile duct dilatation on magnetic resonance cholangiopancreatography.

Rana SS, Bhasin DK, Sharma V, Rao C, Gupta R, Singh K - Ann Gastroenterol (2013)

Bottom Line: All the patients with abnormal liver function tests had a detectable CBD pathology whereas 20/30 (66.6%) patients with normal liver biochemistry had normal EUS findings.There was no significant difference in the mean CBD diameter between the groups with demonstrable pathology compared with those without (P=0.64).The mean CBD diameter and the presence of normal liver function tests are not predictive of underlying pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Vishal Sharma, Chalapathi Rao, Kartar Singh.

ABSTRACT

Background: Dilated common bile duct (CBD) without obvious cause is a not uncommon finding on magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to evaluate the diagnostic performance of endoscopic ultrasound (EUS) in patients with unexplained dilated CBD on MRCP.

Methods: Patients referred for EUS evaluation of a dilated CBD were retrospectively analyzed with respect to serum alkaline phosphatase prior to EUS and subsequent outcome after EUS.

Results: Over a 3-year period, 40 patients (24 males; mean age 38.9±9.9 years) with dilated CBD were retrospectively identified. Ten patients had elevated serum alkaline phosphatase. The diagnosis reached after EUS examination was: CBD stones in 15 (37.5%) with largest size of CBD stone being 9 mm, mass in CBD in 2 (5%), benign biliary stricture in 2 (5%), biliary stricture with underlying chronic pancreatitis in 1 (2.5%) patient respectively. EUS examination revealed normal CBD in 20 (50%) patients and two of these patients had periampullary diverticulum. All the patients with abnormal liver function tests had a detectable CBD pathology whereas 20/30 (66.6%) patients with normal liver biochemistry had normal EUS findings. There was no significant difference in the mean CBD diameter between the groups with demonstrable pathology compared with those without (P=0.64).

Conclusion: EUS is a useful investigational modality for patients with unexplained dilated CBD on MRCP. The mean CBD diameter and the presence of normal liver function tests are not predictive of underlying pathology.

No MeSH data available.


Related in: MedlinePlus

EUS in a patient with dilated common bile duct showing bile duct tumor
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Figure 3: EUS in a patient with dilated common bile duct showing bile duct tumor

Mentions: Over a 3-year period, 40 patients (24 males; mean age 38.9±9.9 years; Table 1) met the inclusion criteria. Of these 40 patients, 28 (70%) patients had undergone side viewing endoscopy using a duodenoscope prior to EUS examination and all of them had normal ampulla. None of these 40 patients had jaundice. Six (15%) patients had history of biliary colic whereas 30 (75%) patients underwent abdominal imaging because of history of vague upper abdominal discomfort. In four patients a dilated CBD was found on abdominal imaging done for evaluation of other systems. Seventeen (42.5%) patients had prior cholecystectomy. Ten (25%) patients had elevated serum alkaline phosphatase and the mean CBD diameter on MRCP was 8.9±1.1 mm. The mean CBD diameter in patients who had undergone cholecystectomy was 8.8±0.98 mm and this was not significantly different from patients with intact gallbladder (9.1±1.1 mm; P=0.50). The diagnosis reached after EUS examination was: CBD stones in 15 (37.5%) with largest size of CBD stone being 9 mm, mass in CBD in 2 (5%), benign biliary stricture in 2 (5%), biliary stricture with underlying chronic pancreatitis in 1 (2.5%) patient (Fig. 1, 2, 3).


Role of endoscopic ultrasound in evaluation of unexplained common bile duct dilatation on magnetic resonance cholangiopancreatography.

Rana SS, Bhasin DK, Sharma V, Rao C, Gupta R, Singh K - Ann Gastroenterol (2013)

EUS in a patient with dilated common bile duct showing bile duct tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959517&req=5

Figure 3: EUS in a patient with dilated common bile duct showing bile duct tumor
Mentions: Over a 3-year period, 40 patients (24 males; mean age 38.9±9.9 years; Table 1) met the inclusion criteria. Of these 40 patients, 28 (70%) patients had undergone side viewing endoscopy using a duodenoscope prior to EUS examination and all of them had normal ampulla. None of these 40 patients had jaundice. Six (15%) patients had history of biliary colic whereas 30 (75%) patients underwent abdominal imaging because of history of vague upper abdominal discomfort. In four patients a dilated CBD was found on abdominal imaging done for evaluation of other systems. Seventeen (42.5%) patients had prior cholecystectomy. Ten (25%) patients had elevated serum alkaline phosphatase and the mean CBD diameter on MRCP was 8.9±1.1 mm. The mean CBD diameter in patients who had undergone cholecystectomy was 8.8±0.98 mm and this was not significantly different from patients with intact gallbladder (9.1±1.1 mm; P=0.50). The diagnosis reached after EUS examination was: CBD stones in 15 (37.5%) with largest size of CBD stone being 9 mm, mass in CBD in 2 (5%), benign biliary stricture in 2 (5%), biliary stricture with underlying chronic pancreatitis in 1 (2.5%) patient (Fig. 1, 2, 3).

Bottom Line: All the patients with abnormal liver function tests had a detectable CBD pathology whereas 20/30 (66.6%) patients with normal liver biochemistry had normal EUS findings.There was no significant difference in the mean CBD diameter between the groups with demonstrable pathology compared with those without (P=0.64).The mean CBD diameter and the presence of normal liver function tests are not predictive of underlying pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Vishal Sharma, Chalapathi Rao, Kartar Singh.

ABSTRACT

Background: Dilated common bile duct (CBD) without obvious cause is a not uncommon finding on magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to evaluate the diagnostic performance of endoscopic ultrasound (EUS) in patients with unexplained dilated CBD on MRCP.

Methods: Patients referred for EUS evaluation of a dilated CBD were retrospectively analyzed with respect to serum alkaline phosphatase prior to EUS and subsequent outcome after EUS.

Results: Over a 3-year period, 40 patients (24 males; mean age 38.9±9.9 years) with dilated CBD were retrospectively identified. Ten patients had elevated serum alkaline phosphatase. The diagnosis reached after EUS examination was: CBD stones in 15 (37.5%) with largest size of CBD stone being 9 mm, mass in CBD in 2 (5%), benign biliary stricture in 2 (5%), biliary stricture with underlying chronic pancreatitis in 1 (2.5%) patient respectively. EUS examination revealed normal CBD in 20 (50%) patients and two of these patients had periampullary diverticulum. All the patients with abnormal liver function tests had a detectable CBD pathology whereas 20/30 (66.6%) patients with normal liver biochemistry had normal EUS findings. There was no significant difference in the mean CBD diameter between the groups with demonstrable pathology compared with those without (P=0.64).

Conclusion: EUS is a useful investigational modality for patients with unexplained dilated CBD on MRCP. The mean CBD diameter and the presence of normal liver function tests are not predictive of underlying pathology.

No MeSH data available.


Related in: MedlinePlus