Malik Shahid, Kaushik Neeraj, Khalid Asif, Bauer Kathy, Brody Debra, Slivka Adam, McGrath Kevin
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Dig Dis Sci. 2007 Feb;52(2):508-12. doi: 10.1007/s10620-006-9582-6. Epub 2007 Jan 9.
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.
腹部影像学检查发现胆总管（CBD）扩张常常需要进一步检查。我们的印象是，在血清肝酶正常的情况下，对扩张的CBD进行内镜超声（EUS）评估的检查收益较低。因此，我们试图评估在血清肝酶正常与升高的患者中，EUS评估CBD扩张的收益情况。我们进行了一项回顾性研究，以确定在先前影像学检查未发现明显病变的情况下，因扩张的CBD而接受EUS评估的患者。查阅病历以了解患者症状、血清肝酶升高情况、EUS检查前的影像学研究以及EUS检查结果。排除标准包括临床黄疸、已知的胆管狭窄、肿块病变或结石，以及先前的括约肌切开术和/或支架置入术。共确定了47例患者：32例血清肝酶正常，15例血清肝酶升高。两组之间的平均CBD直径无差异（8.51对8.79mm，p = 0.854）。在整个研究组中，15例患者曾接受过先前的磁共振胰胆管造影（MRCP）检查；另外7例患者曾接受过先前的内镜逆行胰胆管造影（ERCP）检查。与血清肝酶正常的患者相比，血清肝酶升高的患者中更常发现能解释CBD扩张的EUS检查结果（53%对6%，p = 0.001）。壶腹周围憩室和胆总管结石是最常见的发现；在32例血清肝酶正常的患者中，分别发现了1个壶腹周围憩室和1个CBD结石。先前的MRCP检查漏诊了CBD结石。在15例血清肝酶升高的患者中，有3例胆总管结石、4例壶腹周围憩室和1例壶腹肿瘤。当初始影像学检查正常时，EUS应作为进一步评估CBD扩张的首选检查。虽然在血清肝酶正常情况下胆管扩张时EUS的检查收益较低，但其优先使用可能会避免不必要的MRCP和ERCP检查。
