Chen Chien-Hua, Yang Chi-Chieh, Yeh Yung-Hsiang, Yang Tsang, Chung Tieh-Chi
Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan; Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan; Meiho University, Pingtung, Taiwan; Hungkuang University, Taichung, Taiwan.
Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan.
J Formos Med Assoc. 2015 Sep;114(9):820-8. doi: 10.1016/j.jfma.2013.09.005. Epub 2013 Sep 30.
BACKGROUND/PURPOSE: Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies.
We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US.
The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p < 0.05). The accuracy of EUS was 95.9% (118/123) for overall cause of suspected obstructive jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p > 0.05).
Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice.
背景/目的：超声检查（US）无法显示黄疸患者胆道扩张的所有病因。因此，我们评估了在超声检查未发现明确病变时，内镜超声检查（EUS）对疑似梗阻性黄疸的病因诊断率。此外，我们试图确定最常见病因的预测因素。
我们对123例连续接受EUS检查的疑似梗阻性黄疸患者进行了回顾性研究，这些患者在超声检查中未发现明确病变。
最常见的诊断包括无病理性梗阻（n = 43）、胰胆恶性肿瘤（n = 41）和胆总管结石（n = 28）。胰胆恶性肿瘤与胆总管（CBD）扩张有关，发热和丙氨酸转氨酶升高是胆总管结石的预测因素（p < 0.05）。EUS对疑似梗阻性黄疸总体病因的诊断准确率为95.9%（118/123），无病理发现的诊断准确率为100%（40/40），壶腹癌为100%（23/23），胰腺癌为100%（13/13），CBD癌为75%（3/4），胆总管结石为92.9%（26/28）。除了2例局灶性慢性胰腺炎被误诊为胰腺癌的患者外，EUS漏诊了1例CBD癌患者和2例胆总管结石患者。EUS在确定胰胆恶性肿瘤和胆总管结石方面的总体准确率相当（97.6%，40/41 vs. 92.9%，26/28；p > 0.05）。
明显的CBD扩张（≥12mm）应提醒我们恶性肿瘤的高风险，CBD扩张和发热提示胆总管结石。EUS检查结果阴性不能排除临床疑似梗阻性黄疸患者存在任何病理性梗阻。
