Royal Blackburn Hospital, UK.
William Harvey Hospital, UK.
Pancreatology. 2020 Jul;20(5):992-996. doi: 10.1016/j.pan.2020.05.008. Epub 2020 Jun 8.
BACKGROUND/OBJECTIVES: Dilatation of the pancreatic duct and common bile duct, known as double duct sign (DDS), suggests sinister pathology at the periampullary region. Non-jaundiced patients with incidental DDS and otherwise normal cross-sectional imaging present a diagnostic dilemma to the multidisciplinary team (MDT). The primary aim of this review was to assess the diagnostic yield of endoscopic ultrasound (EUS) in detecting causal pathology in this patient population.
A systematic literature search (Medline, EMBASE, Google Scholar, Cochrane database and PROSPERO) was performed to identify original studies that reported EUS findings in patients with incidental DDS. Primary outcome was detection of a periampullary tumour. Secondary outcome was detection of benign causal pathology. Meta-analysis was used to calculate an absolute measure (pooled proportion) of pathology detection.
Four studies (177 patients) were included. EUS detection rate for a periampullary tumour was 5% (95% CI, 0-10%) including both adenocarcinomas and adenomas. EUS detection rate for benign causal pathology was 22% (95% CI, 10-34%), the most common being chronic pancreatitis CONCLUSION: Non-jaundiced patients with incidental DDS on cross-sectional imaging have a 5% risk of a periampullary tumour that can be detected by EUS.
背景/目的：胰管和胆总管扩张，即双管征（DDS），提示壶腹周围区域存在恶性病变。对于多学科团队（MDT）来说，偶然发现 DDS 且横断面成像无异常的非黄疸患者存在诊断难题。本综述的主要目的是评估超声内镜（EUS）在检测该患者人群中因果性病变方面的诊断效果。
系统地检索了 Medline、EMBASE、Google Scholar、Cochrane 数据库和 PROSPERO 中的文献，以确定报告偶然发现 DDS 的患者 EUS 发现的原始研究。主要结局是检测壶腹周围肿瘤。次要结局是检测良性病因。采用荟萃分析计算病理学检测的绝对指标（汇总比例）。
共纳入 4 项研究（177 例患者）。EUS 检测到壶腹周围肿瘤的检出率为 5%（95%CI，0-10%），包括腺癌和腺瘤。EUS 检测良性病因的检出率为 22%（95%CI，10-34%），最常见的是慢性胰腺炎。
横断面成像偶然发现 DDS 的非黄疸患者有 5%的机会发生壶腹周围肿瘤，可通过 EUS 检测到。
