Digestive Disease Research Institute, Tehran, Iran.
Endosc Ultrasound. 2014 Apr;3(Suppl 1):S3-4.
Occasionally, common bile duct (CBD) dilatation is discovered while working up patients for various causes. Not infrequently, the usual imaging modalities fail to identify the cause and endoscopic ultrasonography (EUS) becomes necessary. The aim of this study is to assess the value of EUS in identifying the cause of CBD dilatation undiagnosed by transabdominal ultrasonography.
During 1 year, 152 consecutive patients who were referred for evaluation of dilated CBD (diameter ≥7 mm) discovered incidentally during transabdominal ultrasonography were included. Final diagnoses were confirmed by endoscopic retrograde cholangiopancreatography, EUS-guided fine-needle aspiration, surgical exploration, or clinical follow-up of at least 10 months.
One hundred and fifty two patients (54% female) with dilated CBD were included. Mean age of patients was 60 ± 17 years. The final diagnoses was 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 neoplasia in 15 (15.8%), cholangiocarcinoma in 14 (9.2%) and pancreatic head cancer in 9 (5.9%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS for patients with abnormal EUS was 89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively.
After diagnosis of CBD dilation by transabdominal ultrasonography, EUS may be a reasonable next choice for determining the etiology of dilated CBD.
在因各种原因对患者进行检查时，偶尔会发现胆总管（CBD）扩张。通常，常规的影像学检查无法确定病因，因此需要进行内镜超声检查（EUS）。本研究旨在评估 EUS 对经腹部超声检查未发现的 CBD 扩张病因的诊断价值。
在 1 年期间，共纳入 152 例因经腹部超声检查意外发现 CBD 扩张（直径≥7mm）而被转介进行评估的连续患者。最终诊断通过内镜逆行胰胆管造影、EUS 引导下细针抽吸、手术探查或至少 10 个月的临床随访来确定。
共纳入 152 例 CBD 扩张患者（54%为女性）。患者的平均年龄为 60±17 岁。最终诊断为胆总管结石 32 例（21.1%）、CBD 结石通过 35 例（23%）、阿片类药物诱导的 CBD 扩张 14 例（9.2%）、胆囊切除术后状态 20 例（13.1%）、壶腹周围肿瘤 15 例（15.8%）、胆管癌 14 例（9.2%）和胰头癌 9 例（5.9%）。EUS 对异常 EUS 患者的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 89.5%、100.0%、100.0%、91.2%和 90.9%。
在经腹部超声检查诊断 CBD 扩张后，EUS 可能是确定 CBD 扩张病因的合理选择。
