Further evaluation with EUS in patients with incidental common bile duct dilatation or double duct sign. A retrospective study from a tertiary hospital

Aims Common bile duct (CBD) dilatation, whether isolated or accompanied by the double duct sign (indicating dilatation of both the CBD and the pancreatic duct), along with abnormal liver enzyme levels, is highly predictive of biliary disease. These findings can be effectively identified through imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP). However, unexplained dilatation on imaging in asymptomatic patients may still warrant further investigation via endoscopic ultrasound (EUS) to identify any occult causes. The literature supporting the importance of using EUS in these conditions is evolving, and there is currently no clear evidence-based approach to evaluate asymptomatic patients with dilated ducts. Thus, our aim is to investigate the diagnostic yield of EUS in cases of unexplained CBD dilatation or the double duct sign in asymptomatic individuals presenting with normal liver enzyme levels.

Methods A retrospective data analysis was conducted from March 2017 to October 2024 in a tertiary hospital on asymptomatic patients with a dilated CBD of 7 mm or more and 9 mm if the patient had a cholecystectomy history or double duct sign with normal liver enzymes.

Results 20 EUS procedures were indicated for unexplained dilated CBD or double duct sign on imaging with normal liver enzymes. 50% of the patients were male (10/20) with a mean age of 67±10.6 years. The median diameter of the CBD was 11.4±1.09 mm. 12(60%) patients had CBD dilatation alone, 7 (35%) had double duct sign and 1(5%) had no CBD dilatation. Τhe results after EUS in patients who had CBD dilatation alone were as follows: no pathology in 5 (41%) patients, choledochocele in 4 (33%), CBD stone in 3 (25%). On the other hand, the results of EUS in those with double duct sign were as follows: choledochocele in 3 (42%) patients, chronic pancreatitis in 2 (28%), biliary stone in one patient (14%), and pancreatic adenocarcinoma in one patient (14%). The overall diagnostic yield of EUS was 70% (14/20 patients).

Conclusions Unexplained CBD dilatation or double duct sign on imagining in patients with normal liver enzymes should warrant further investigation with EUS to avoid missing serious pathological conditions such as stones, choledochocele or cancer.

Publication History

Article published online:
27 March 2025