Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.
Weill Cornell Medicine, New York, New York USA.
Gastrointest Endosc. 2021 Nov;94(5):890-901.e8. doi: 10.1016/j.gie.2021.07.002. Epub 2021 Jul 7.
Common bile duct (CBD) dilation is a frequent indication for EUS. Among asymptomatic individuals, biliary dilation may not be clinically significant; however, EUS is often relied on for the exclusion of benign and malignant pathology that might require further intervention. The yield of EUS evaluation for this indication is not well characterized and has significant implications for health resource utilization because asymptomatic biliary dilation is prevalent. Through this systematic review, we sought to appraise the yield of EUS evaluation of asymptomatic patients with radiologic evidence of isolated CBD dilation.
A protocolled search (PROSPERO: CRD42020193428) extracted original studies from the Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science Core Collection that described diagnostic yield of EUS among asymptomatic patients with biliary dilation. Cumulative EUS diagnostic yield was calculated through meta-analysis of proportions using inverse variance methods and a random-effects model.
Of 2616 studies, 8 delineated the EUS yield among 224 asymptomatic patients. The cumulative yield of EUS for any pathology was 11.2% (95% confidence interval [CI], 3.6%- 21.6%). The EUS yield for benign etiologies was 9.2% (95% CI, 1.1%-21.9%), of which choledocholithiasis comprised 3.4% (95% CI, 0%-11.2%) and malignant etiologies .5% (95% CI, 0%-3.4%) of cases.
EUS in patients with asymptomatic CBD dilation does yield findings of choledocholithiasis and malignancy, albeit at low rates. A cost-effectiveness analysis is warranted to further guide clinical decision-making in this area.
胆总管（CBD）扩张是 EUS 的常见适应证。在无症状个体中，胆道扩张可能没有临床意义；然而，EUS 通常用于排除可能需要进一步干预的良性和恶性病变。对于这种适应证，EUS 评估的结果并不明确，并且对卫生资源的利用有重大影响，因为无症状的胆道扩张很常见。通过这项系统评价，我们旨在评估 EUS 评估有放射学证据的孤立性 CBD 扩张的无症状患者的结果。
通过协议搜索（PROSPERO：CRD42020193428）从 Cochrane 图书馆、Ovid Embase、Google Scholar、Ovid Medline、PubMed、Scopus 和 Web of Science 核心合集提取了描述 EUS 在有胆道扩张的无症状患者中的诊断结果的原始研究。通过使用逆方差法和随机效应模型对比例进行荟萃分析计算累积 EUS 诊断结果。
在 2616 项研究中，有 8 项研究描述了 224 例无症状患者的 EUS 结果。EUS 对任何病理的累积结果为 11.2%（95%置信区间[CI]，3.6%-21.6%）。EUS 对良性病因的结果为 9.2%（95%CI，1.1%-21.9%），其中胆石症占 3.4%（95%CI，0%-11.2%），恶性病因占.5%（95%CI，0%-3.4%）。
EUS 在无症状 CBD 扩张患者中确实能发现胆石症和恶性肿瘤，但发生率较低。需要进行成本效益分析，以进一步指导该领域的临床决策。
