DILATION OF THE COMMON BILE DUCT OF INDETERMINATE CAUSE – THE ROLE OF ENDOSCOPIC ULTRASONOGRAPHY

Aims:

Dilation of the common bile duct (CBD) of undetermined cause is commonly observed in clinical practice and may have multiple etiologies. The aim of this study was to identify positive endoscopic ultrasonography (EUS) predictors and to assess agreement with magnetic resonance cholangiopancreatography (MRCP).

Methods:

Retrospective study including patients who underwent EUS for dilation of CBP detected on ultrasound (VBP>= 7 mm) or computerized tomography (VBP>= 10 mm) with no identified cause between 2010 – 2017.

Results:

We included 56 patients – mean age of 70 years, 70% female, 29% cholecystectomized. The EUS was positive in 30% of the patients – 6 patients had choledocholithiasis, 3 ampuloma, 2 choledochal cyst, 2 benign CBD stenosis, 1 cyst of the head of the pancreas, 1 cholangiocarcinoma, 1 chronic pancreatitis and 1 CBD compression due to adenomegaly.

Factors positively related with findings in EUS were an increased gamma glumatyl 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).

MRCP was concordant with EUS findings in 76% of the cases (n = 46; MRCP did not identify 3 cases of lithiasis, 2 ampulomas and 1 CBD compression due to adenomegaly and EUS did not identify 3 cases of benign stenosis CBD, 1 choledocholithiasis and 1 cyst of the bile duct). Seven patients repeated EUS and the findings were concordant with first in 86% of cases (1 case of unidentified ampuloma in the first EUS).

Conclusions:

EUS identified a cause for CBD dilatation in 30% of cases, with increased cholestasis enzymes, increased TB and presence of signs and symptoms being predictors of a positive test. Agreement with MRCP was 76%.