Sousa Mafalda, Fernandes Sónia, Proença Luísa, Fernandes Carlos, Silva João, Gomes Ana Catarina, Afecto Edgar, Carvalho João
Gastrenterologia, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal.
Gastroenterology, Centro Hospitalar de Gaia/Espinho.
Rev Esp Enferm Dig. 2019 Oct;111(10):757-759. doi: 10.17235/reed.2019.6278/2019.
with the widespread use of abdominal imaging, common bile duct (CBD) dilation is a common problem in the daily practice. However, the significance of a dilated CBD as a predictor of underlying disease has not been well elucidated and there are currently no guidelines for its approach.
this was a retrospective study of patients who underwent endoscopic ultrasonography (EUS) from 2010 to 2017 due to a dilated CBD detected by transabdominal ultrasonography TUS (CBD ≥ 7 mm) or computed tomography (CT) (CBD ≥ 10 mm), with no identified cause (n = 56). The aims were to assess the diagnostic yield of EUS and to identify predictors for a positive EUS.
the majority of patients (n = 39) had normal findings on EUS. Abnormal EUS findings were found in 30% (n = 17) of the patients, which included choledocholithiasis (n = 6), ampuloma (n = 3), choledochal cyst (n = 2), benign CBD stenosis (n = 2), cyst of the head of the pancreas (n = 1), cholangiocarcinoma (n = 1), chronic pancreatitis (n = 1) and CBD compression due to adenomegaly (n = 1). Factors that positively related with findings on EUS were increased levels of gamma glutamyl transferase (331 U/l vs 104 U/l, p = 0.039), alkaline phosphatase (226 U/l vs 114 U/l, p = 0.041), total bilirubin (TB) (6.5 g/dl vs 1.2 g/dl, p = 0.035) and the presence of signs/symptoms (p = 0.042). Of the 21 patients (38%) who were asymptomatic with normal liver biochemical tests, four (19%) had findings on EUS.
the majority of patients with a dilation of the CDB have a normal EUS. Increased cholestasis enzymes, increased TB and the presence of signs and symptoms are predictors of a positive EUS.
随着腹部影像学检查的广泛应用，胆总管（CBD）扩张在日常临床实践中是一个常见问题。然而，扩张的胆总管作为潜在疾病预测指标的意义尚未得到充分阐明，目前也没有针对其处理的指南。
这是一项对2010年至2017年间因经腹部超声（TUS）检测到胆总管扩张（CBD≥7mm）或计算机断层扫描（CT）检测到胆总管扩张（CBD≥10mm）且未发现病因的患者进行的回顾性研究（n = 56）。目的是评估内镜超声（EUS）的诊断率，并确定EUS阳性的预测因素。
大多数患者（n = 39）的EUS检查结果正常。30%（n = 17）的患者EUS检查结果异常，其中包括胆总管结石（n = 6）、壶腹瘤（n = 3）、胆总管囊肿（n = 2）、良性胆总管狭窄（n = 2）、胰头囊肿（n = 1）、胆管癌（n = 1）、慢性胰腺炎（n = 1）和因肿大引起的胆总管压迫（n = 1）。与EUS检查结果呈正相关的因素包括γ-谷氨酰转移酶水平升高（331 U/L对104 U/L，p = 0.039）、碱性磷酸酶（226 U/L对114 U/L，p = 0.041）、总胆红素（TB）（6.5 g/dl对1.2 g/dl，p = 0.035）以及体征/症状的存在（p = 0.042）。在21例（38%）无症状且肝脏生化检查正常的患者中，4例（19%）EUS检查有异常发现。
大多数胆总管扩张患者的EUS检查结果正常。胆汁淤积酶升高、TB升高以及体征和症状的存在是EUS阳性的预测因素。
