内镜超声对横断面成像检查发现的无明确病因的胆总管扩张的诊断价值

Diagnostic Value of Endoscopic Ultrasonography for Common Bile Duct Dilatation without Identifiable Etiology Detected from Cross-Sectional Imaging.

作者信息

Pausawasdi Nonthalee, Hongsrisuwan Penprapai, Kamani Lubna, Maipang Kotchakon, Charatcharoenwitthaya Phunchai

机构信息

Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Clin Endosc. 2022 Jan;55(1):122-127. doi: 10.5946/ce.2021.122. Epub 2022 Jan 3.

DOI:10.5946/ce.2021.122

PMID:34974680

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8831402/

Abstract

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.

METHODS

Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.

RESULTS

A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98 (95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91 (95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× the upper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathological obstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively.

CONCLUSION

EUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectional imaging.

摘要

背景/目的：当横断面成像显示胆总管（CBD）扩张但病因不明时，需要进行内镜超声检查（EUS）。本研究旨在评估EUS对病因不明的CBD扩张的诊断性能。

方法

回顾性分析2012年至2017年间接受EUS检查且CBD扩张但病因不明确的患者。

结果

共纳入131例患者。平均年龄为63.2±14.1岁。最常见的表现是肝功能异常（85.5%）。CBD平均直径为12.2±4.1mm。EUS识别出的包括恶性肿瘤、胆总管结石和良性胆管狭窄（BBS）等病变的受试者操作特征曲线下面积（AUROC）为0.98（95%置信区间[CI]，0.95-1.00）。EUS检测恶性肿瘤、胆总管结石和BBS的AUROC分别为0.91（95%CI，0.85-0.97）、1.00（95%CI，1.00-1.00）和0.93（95%CI，0.87-0.99）。男性、丙氨酸氨基转移酶≥正常上限（ULN）的3倍、碱性磷酸酶≥ULN的3倍以及肝内胆管扩张是病理性梗阻的预测因素，比值比分别为5.46（95%CI，1.74-17.1）、5.02（95%CI，1.48-17.0）、4.63（95%CI，1.1-19.6）和4.03（95%CI，1.37-11.8）。