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Ludwig DR, Itani M, Childs DD, Revzin MV, Das KK, Anderson MA, Arif-Tiwari H, Lockhart ME, Fulcher AS. Biliary Duct Dilatation: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329671. [PMID: 37493325 DOI: 10.2214/ajr.23.29671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Biliary duct dilatation is a common incidental finding in practice, but it is unlikely to indicate biliary obstruction in the absence of clinical symptoms or elevated levels on liver function tests (LFTs). However, the clinical presentation may be nonspecific, and LFTs may either be unavailable or difficult to interpret. The goal of this AJR Expert Panel Narrative Review is to highlight a series of topics fundamental to the management of biliary duct dilatation, providing consensus recommendations in a question-and-answer format. We start by covering a basic approach to interpreting LFT results, the strengths and weaknesses of the biliary imaging modalities, and how and where to measure the extrahepatic bile duct. Next, we define the criteria for biliary duct dilatation, including patients with prior cholecystectomy and advanced age, and discuss when and whether biliary duct dilatation can be attributed to papillary stenosis or sphincter of Oddi dysfunction. Subsequently, we discuss two conditions in which the duct is pathologically dilated but not obstructed: congenital cystic dilatation (i.e., choledochal cyst) and intraductal papillary neoplasm of the bile duct. Finally, we provide guidance regarding when to recommend obtaining additional imaging or testing, such as endoscopic ultrasound or ERCP, and include a discussion of future directions in biliary imaging.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110
| | - David D Childs
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Koushik K Das
- Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona College of Medicine, Tucson, AZ
| | - Mark E Lockhart
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Ann S Fulcher
- Department of Radiology, Medical College of Virginia/Virginia Commonwealth Medical Center, Richmond, VA
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Ovalle-Chao C, Guajardo-Nieto DA, Elizondo-Pereo RA. Performance of the predictive criteria of the American Society for Gastrointestinal Endoscopy in the diagnosis of choledocholithiasis at a secondary care public hospital in the State of Nuevo León, Mexico. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:322-332. [PMID: 35810095 DOI: 10.1016/j.rgmxen.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND AIMS Currently there is no ideal diagnostic/therapeutic approach for patients with suspected choledocholithiasis. The primary aim of our study was to evaluate the performance of the criteria for predicting choledocholithiasis proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2019. MATERIALS AND METHODS A retrospective study was conducted that included 352 patients seen at a secondary care public healthcare institution in Monterrey, Nuevo León, that treats an open population and does not have endoscopic ultrasound or magnetic resonance cholangiopancreatography at its disposal. RESULTS The most frequent predictor presented by the patients was abnormal liver function tests (90.63%), and with their use alone, sensitivity was higher than that of all the predictors analyzed (91.41%). In addition, the finding of common bile duct stones on ultrasound imaging was the only predictor independently associated with the confirmatory diagnosis of choledocholithiasis. Regarding the general performance of the 2019 criteria, the high-risk category had 68.75% sensitivity, 52.08% specificity, a positive predictive value of 79.28%, a negative predictive value of 38.46%, diagnostic accuracy of 64.20%, and a confirmatory diagnosis of choledocholithiasis in 79.28% of the patients of that risk category. CONCLUSIONS The study corroborated that the presence of choledocholithiasis could be predicted using the choledocholithiasis predictors and risk categories proposed by the ASGE, with acceptable accuracy, in accordance with the standards suggested by those same guidelines.
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Affiliation(s)
- C Ovalle-Chao
- Departamento de Cirugía General, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Monterrey, Nuevo León, Mexico.
| | - D A Guajardo-Nieto
- Departamento de Cirugía General, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Monterrey, Nuevo León, Mexico
| | - R A Elizondo-Pereo
- Departamento de Enseñanza e Investigación en Salud, Christus Muguerza Hospital Alta Especialidad, Monterrey, Nuevo León, Mexico
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Beyer G, Kasprowicz F, Hannemann A, Aghdassi A, Thamm P, Volzke H, Lerch MM, Kühn JP, Mayerle J. Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study. Gut 2023; 72:1738-1744. [PMID: 36828626 PMCID: PMC10423481 DOI: 10.1136/gutjnl-2021-326106] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Changes of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper reference ranges are missing. DESIGN Cross-sectional whole body MRI data from the population-based Study of Health in Pomerania were analysed. The width of the common bile duct (CBD) and the pancreatic duct (PD) was determined. We aimed to describe the distribution of physiological duct diameters on MRCP in a population of healthy subjects and to identify factors influencing duct size. RESULTS After excluding pre-existing pancreaticobiliary conditions, CBD and PD diameters from 938 and 774 healthy individuals, respectively, showed a significant increase with age (p<0.0001) and exceeded the conventional upper reference limit of normal in 10.9% and 18.2%, respectively. Age-dependent upper reference limits of duct diameters were delineated with non-parametric quantile regression, defined as 95th percentile: for CBD up to 8 mm in subjects <65 years and up to 11 mm in subjects ≥65 years. For the PD reference diameters were up to 3 mm in subjects <65 years and up to 4 mm in subjects ≥65 years. CONCLUSIONS This is the first population-based study delineating age-adjusted upper reference limits of CBD and PD on MRCP. We showed that up to 18.2% of healthy volunteers would have needed diagnostic workup, if the conventional reference values were used. The utilisation of the adapted reference levels may help to avoid unnecessary investigations and thus to reduce healthcare expenditure and test-related adverse events.
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Affiliation(s)
- Georg Beyer
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Kasprowicz
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Patrick Thamm
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Henry Volzke
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
- Institute for Community Medicine, Clinical Epidemiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, Carl-Gustav-Carus, Dresden, Sachsen, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Jimenez-Romero C, Justo-Alonso I, del Pozo-Elso P, Marcacuzco-Quinto A, Martín-Arriscado-Arroba C, Manrique-Municio A, Calvo-Pulido J, García-Sesma A, San Román R, Caso-Maestro O. Post-transplant biliary complications using liver grafts from deceased donors older than 70 years: Retrospective case-control study. World J Gastrointest Surg 2023; 15:1615-1628. [PMID: 37701699 PMCID: PMC10494601 DOI: 10.4240/wjgs.v15.i8.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 06/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors. AIM To determine the incidence, outcomes, and risk factors for biliary complications (BC) in liver transplantation (LT) using liver grafts from donors aged > 70 years. METHODS Between January 1994 and December 31, 2019, 297 LTs were performed using donors older than 70 years. After excluding 47 LT for several reasons, we divided 250 LTs into two groups, namely post-LT BC (n = 21) and without BC (n = 229). This retrospective case-control study compared both groups. RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique (76.2% in the BC group vs 92.6% in the non-BC group). Twenty-one patients (8.4%) developed BC (13 anastomotic strictures, 7 biliary leakages, and 1 non-anastomotic biliary stricture). Nine patients underwent percutaneous balloon dilation and nine required a Roux-en-Y hepaticojejunostomy because of dilation failure. The incidence of post-LT complications (graft dysfunction, rejection, renal failure, and non-BC reoperations) was similar in both groups. There were no significant differences in the patient and graft survival between the groups. Moreover, only three deaths were attributed to BC. While female donors were protective factors for BC, donor cardiac arrest was a risk factor. CONCLUSION The incidence of BC was relatively low on using liver grafts > 70 years. It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy, without significant differences in the patient or graft survival between the groups.
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Affiliation(s)
- Carlos Jimenez-Romero
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Iago Justo-Alonso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Pilar del Pozo-Elso
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alberto Marcacuzco-Quinto
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | | | - Alejandro Manrique-Municio
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Jorge Calvo-Pulido
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Alvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Ricardo San Román
- Department of Radiology, `12 de Octubre´ University Hospital, Madrid 28041, Spain
| | - Oscar Caso-Maestro
- Unit of HPB Surgery and Abdominal Organs Transplantation, `12 de Octubre´ University Hospital, Madrid 28041, Spain
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Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE): A Retrospective Study. Surg Laparosc Endosc Percutan Tech 2023; 33:62-68. [PMID: 36630657 PMCID: PMC9889197 DOI: 10.1097/sle.0000000000001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n=56) and a remote LC group (group B, n=29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B.Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals.Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups. RESULTS In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter ( P <0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group ( P <0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter ( P <0.05). CONCLUSIONS This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.
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Sundaram KM, Morgan MA, Itani M, Thompson W. Imaging of benign biliary pathologies. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:106-126. [PMID: 35201397 DOI: 10.1007/s00261-022-03440-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/21/2023]
Abstract
Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Malak Itani
- Mallinkckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA
| | - William Thompson
- Department of Radiology, University of New Mexico, Albuquerque, USA
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TRPC6-protein expression in the elderly and in liver disease. Ann Anat 2023; 245:152016. [DOI: 10.1016/j.aanat.2022.152016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
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Utilizing CT to identify clinically significant biliary dilatation in symptomatic post-cholecystectomy patients: when should we be worried? ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4126-4138. [PMID: 36104482 DOI: 10.1007/s00261-022-03660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients. METHODS In this IRB approved retrospective study, two attending radiologists independently reviewed CT imaging for 118 post-cholecystectomy patients, who were subsequently evaluated with MRCP, ERCP, or EUS, prompted by findings on the CT and clinical status. Measurements of the common duct (CD) were obtained at the porta hepatis, distal duct, and point of maximal dilation on axial and coronal CT scans. Patients were grouped by whether they required intervention after follow-up imaging. Pertinent baseline lab values and patient demographics were reviewed. RESULTS Of the 118 post-cholecystectomy patients, 38 patients (31%) required intervention, and 80 patients (69%) did not require intervention after follow-up imaging. For both readers, axial and coronal CD diameters were significantly higher in the 'intervention required' vs 'no intervention' groups at all locations (p value < 0.05). There was good to excellent inter-reader agreement at all locations (ICC 0.68-0.92). Pertinent baseline lab values including AST (p = 0.043), ALT (p = 0.001), alkaline phosphatase (p = 0.0001), direct bilirubin (p = 0.011), total bilirubin (p = 0.028), and WBC (p = 0.043) were significantly higher in the 'intervention required' group. CD thresholds of 8 mm yielded the highest sensitivities (76-95%), and CD thresholds of 12 mm yielded the highest specificities (65-78%). CD combined with bilirubin levels increased sensitivity and specificity, compared to using either feature alone. CONCLUSION Dilated CD on CT combined with bilirubin levels increases the sensitivity and specificity for identifying patients needing intervention. We recommend that a post-cholecystectomy patient who presents with a CD diameter > 10 mm on CT and elevated bilirubin levels should undergo further clinical and imaging follow-up.
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Vardar BU, Dupuis CS, Goldstein AJ, Vardar Z, Kim YH. Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department. Ultrasonography 2022; 41:243-262. [PMID: 35026887 PMCID: PMC8942730 DOI: 10.14366/usg.21152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Ultrasonography is often the initial modality used to evaluate patients found to have abnormal liver function tests (LFTs) in the emergency department. While an assessment for biliary ductal dilatation and obstruction remains one of the main questions to answer, radiologists should also be aware of the ultrasonographic appearance of other conditions that can cause abnormal LFTs. This may be crucial for the management and disposition of patients in the emergency department. This article reviews the ultrasonographic features of diseases that may cause abnormal LFTs.
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Affiliation(s)
| | - Carolyn S Dupuis
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan J Goldstein
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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Management of Patients With Common Bile Duct Dilatation Without a Sonographic Evident Cause: Evaluating the Yield of Subsequent Magnetic Resonance Imaging and Findings Correlated With Causative Pancreaticobiliary Pathology. J Comput Assist Tomogr 2022; 46:163-168. [PMID: 35297572 DOI: 10.1097/rct.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to evaluate the yield of magnetic resonance imaging (MRI) in patients with common bile duct (CBD) dilatation without a sonographic evident cause and to investigate sonographic and laboratory findings at presentation that might predict identification of underlying pancreaticobiliary pathology. METHODS Included were consecutive patients in whom MRI was performed for further evaluation of CBD dilatation detected on ultrasound (US), without a sonographic evident cause, from January 1, 2014, to December 31, 2014. Magnetic resonance imaging and clinical data were retrospectively reviewed. Patients were divided into two groups: patients with and without identified underlying causative pancreaticobiliary pathology. Ultrasound findings and laboratory results at presentation were compared between groups to identify findings suggestive of underlying pancreaticobiliary pathology. RESULTS Fifty-seven patients, with a mean age of 54 ± 16 years including 37 females (65%), underwent MRI. Specific pancreaticobiliary causes for CBD dilatation were identified in 38 patients (66%, 31 benign and 7 malignant). In the remaining patients, no cause was identified in 17 (30%) and MRIs were nondiagnostic in 2 patients. Magnetic resonance imaging accuracy for correctly identifying the underlying cause of CBD dilatation was 91%. Patients with associated intrahepatic bile duct dilatation on US and elevated alanine aminotransferase and alkaline phosphatase were more likely to have underlying pancreaticobiliary pathology (P < 0 .05). No patient with initial negative MRI had pancreaticobiliary malignancy. CONCLUSIONS Magnetic resonance imaging seems to be an accurate noninvasive method for identifying the underlying cause in most patients with CBD dilatation on US and in excluding pancreaticobiliary malignancy. Patients with associated intrahepatic bile duct dilatation and/or elevated liver enzymes are at higher risk of harboring underlying pancreaticobiliary pathology.
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Govindan S, Tamrat NE, Liu ZJ. Effect of Ageing on the Common Bile Duct Diameter. Dig Surg 2021; 38:368-376. [PMID: 34673652 DOI: 10.1159/000519446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of the study was to determine if the common bile duct (CBD) diameter increases physiologically with age and investigate whether gallstones lead to changes in CBD diameter. METHOD Our study is composed of 721 patients in 2 groups: 517 asymptomatic patients and 204 gallstones patients who underwent MRCP. Their CBD diameter was measured at its widest visible portion on MRCP. Simple linear regression of the average of these measurements was used to investigate the relationship between age and CBD diameter in both populations. Subjects were further divided into 8 subgroups age-wise, respectively, and their means compared decade-wise using ANOVA. Furthermore, each subgroup mean from both populations was compared with each other using a t test. RESULTS Among the 517 subjects, the mean CBD diameter was 5.3663 mm ± 1.43546 and correlated with age (p < 0.01), dilating at 0.07 mm/year. The mean diameter of our oldest group was 7.9 mm, resulting in a plausible upper limit of 8 mm for the asymptomatic population. The mean CBD diameter of the cholelithiasis population was 5.6738 mm ± 1.40986 and also correlated with age (p < 0.01). The mean CBD diameter of the age groups from the cholelithiasis population was larger than that from the asymptomatic population, but none were statistically significant. CONCLUSION Although the CBD increases physiologically with age, there is no significant difference in CBD size between the general population and the cholelithiasis patients at any particular age. Gallstones do not independently dilate the CBD.
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Affiliation(s)
- Shankara Govindan
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China,
| | - Nebiyu Elias Tamrat
- Department of Urology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zi Jun Liu
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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Ha TS. Geriatric Physiology for Surgical Intensivists: Part I. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.3.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Geriatric patients tend to have subtle presentations of biliary disorders and, if untreated, can decompensate acutely. Each biliary disorder warrants formulation of an individualized treatment plan with a multidisciplinary approach. Acute cholecystitis, a common complication of gallstones, is initially managed by conservative measures and subsequently, among patients with optimal surgical risk, through laparoscopic or open cholecystectomy. High-risk patients undergo temporization, percutaneous or endoscopic, followed by definitive intervention. Acute cholecystitis with complications (ie, perforation, gangrene, or small bowel obstruction) warrants emergent cholecystectomy. Gallstone migration into the biliary system can cause choledocholithiasis, often complicated by biliary pancreatitis or cholangitis if not intervened. Therapy for choledocholithiasis is based on biliary clearance through endoscopic and, infrequently, surgical approaches.
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Worku MG, Enyew EF, Desita ZT, Moges AM. Sonographic measurement of normal common bile duct diameter and associated factors at the University of Gondar comprehensive specialized hospital and selected private imaging center in Gondar town, North West Ethiopia. PLoS One 2020; 15:e0227135. [PMID: 31971959 PMCID: PMC6977745 DOI: 10.1371/journal.pone.0227135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background The biliary tree is a three-dimensional system of channels that bile flows from the hepatocytes to the gallbladder and to the intestine. Size of the common bile duct (CBD) is a predictor of biliary obstruction and, therefore, its measurement is an important component of biliary system evaluation. Factors like age, height, weight, BMI, previous cholecystectomy, drugs, and type of imaging modality affect CBD diameter, but the duct significantly dilated due to obstructive biliary pathology. Objective To measure the normal CBD diameter and its association with age, sex, and anthropometric measurement at the University of Gondar Comprehensive Specialized Hospital and selected private imaging center, Gondar town, Northwest Ethiopia, 2019. Methods and materials Institutional based cross-sectional study was conducted on 206 subjects without any history of hepatobiliary abnormality. The CBD measured at the proximal part just caudal to the porta hepatis. Descriptive analysis, student t-test, one way ANOVA, correlation and both bivariable and multivariable linear regression analysis were implemented. In bivariable linear regression variables with p-value, less than 0.2 were selected for multivariable analysis and in multivariable linear regression analysis variables with P-Value less than 0.05 were considered as statistically significant. Results The mean age of the study participants was 39.4 (range 18–87). The mean diameter of the CBD was 3.64mm 95%CI (3.52, 3.77), which ranges from 1.8 to 5.9 mm, with 65% of the participant having CBD diameter less than 4mm. The diameter of CBD significantly associated with age with a linear trend. The mean diameter in a rural area was greater than subjects living in an urban area. Independent t-test showed no statistically significant difference in CBD diameter between male and female subjects. Conclusion The lower limit of the CBD diameter for this study was similar to most of the studies, but the upper limit was found to be slightly lower. The diameter was significantly associated with age along the linear trend and it was progressively increased from the lower age group onwards. The diameter of CBD did not show statistically significant association with any of the anthropometric measurement.
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Affiliation(s)
- Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
- * E-mail:
| | - Engdaw Fentahun Enyew
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Zerubabel Tegegne Desita
- Department of Radiology, University of Gondar, college of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Abebe Muche Moges
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
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Does measurement of the hepatic artery velocity improve the sonographic diagnosis of cholangitis? Abdom Radiol (NY) 2019; 44:4004-4010. [PMID: 31673717 DOI: 10.1007/s00261-019-02284-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the frequency of elevated peak systolic proper hepatic artery velocity (HAV) in patients with acute cholangitis and to determine the diagnostic performance of this metric relative to existing criteria. METHODS Between 9/2016 and 11/2017, 107 patients clinically suspected to have cholangitis were referred for an abdominal ultrasound. Of these, 56 patients had HAV measurements and were included in the final analysis. Clinical and imaging features, including HAV, HAV resistive index (RI), portal vein velocity (PVV), biliary dilation, and presence of an obstructive etiology were extracted. The diagnostic performance of HAV was compared to the existing available clinical criteria (Charcot's triad and 2018 Tokyo Guidelines). Elevated HAV was defined as HAV > 100 cm/s. Presence of cholangitis was determined by the discharge summary following medical workup and admission or observation. RESULTS 32% had cholangitis while 68% did not. Average HAV for patients with cholangitis was 152 ± 54 cm/s versus 91 ± 44 cm/s for those without (p < 0.0001; t test). The HAV was elevated in 83% of patients with cholangitis. When considered in isolation, an elevated HAV had a high negative predictive value (90%), was more accurate (77%; 95% confidence interval 64-87%) than Charcot's triad (73%; 60-83%), and had similar accuracy compared to 2018 Tokyo Guidelines (79%; 66-88%). Substitution of conventional imaging criteria with elevated HAV in the 2018 Tokyo Guidelines yielded the highest overall accuracy of 84% (72-92%). CONCLUSION HAV is elevated in the majority of patients with cholangitis. Substitution of an elevated HAV for conventional sonographic criteria is more accurate than existing clinical criteria in identifying patients with cholangitis.
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The accuracy of 3T magnetic resonance cholangiopancreatography in suspected choledocholithiasis. Pol J Radiol 2019; 84:e419-e423. [PMID: 31969960 PMCID: PMC6964331 DOI: 10.5114/pjr.2019.89689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate interobserver agreement during magnetic resonance cholangio-pancreatography (MRCP) evaluation and the sensitivity and specificity of MRCP obtained with 3T scanners in cases of bile duct obstruction. Material and methods A total of 37 patients who had MRCP and endoscopic retrograde cholangiography (ERCP) were included. Choledochal pathology was divided into two groups regarding the presence of stones as "there is stone or not". MRCPs were performed with a 3-Tesla system using respiratory triggered HASTE technique in axial and coronal planes and with T2 SPACE sequence in the coronal plane. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated separately for each observer. The average of both observers was calculated for comparison with other studies. Results Thirty-seven patients were in the study population. Agreement between the observers was analysed, and Cohen's κ value was evaluated as 0.84. For two observers, the sensitivity of MRCP was 93%, whereas the specificity was 75% for the first observer and 62% for the second. Conclusions In this study we found a high level of interobserver agreement in evaluating MRCP. MRCP has a high sensitivity in detecting choledocholithiasis.
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Björnsson HK, Björnsson ES. A significant proportion of patients with choledocholithiasis have markedly elevated alanine aminotransferase. Scand J Gastroenterol 2019; 54:1155-1159. [PMID: 31479284 DOI: 10.1080/00365521.2019.1657177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To determine the frequency and nature of liver enzyme elevations among patients presenting with choledocholithiasis (CDL). Methods: A prospective study identified all patients with serum level of alanine aminotransferase (ALT) ≥500 U/L (normal levels: <70 U/L in men, <45 U/L in women) over 1 year. Additionally, other patients with CDL were identified during the same period retrospectively by diagnostic codes and ERCP procedures, providing data on all CDL patients. Symptoms, liver tests, history of cholecystectomy, and radiological imaging were analyzed. Patients with radiologically confirmed CDL or a clinical diagnosis of CDL were included. Results: During the study period, 110 patients had CDL, 60% women, mean age 65 years. Overall 86/110 (78%) had confirmed CDL on imaging and 24/110 (22%) clinically diagnosed. Overall 26% had undergone cholecystectomy, median bile duct diameter 10.0 mm, median maximal liver tests: ALT 436, ALP 226, bilirubin 60 μmol/L (<25). Overall 9/110 (8%) had ALT ≥1000, 43/110 (39%) ALT levels between 500 and 1000 IU/L and 58/110 (53%) had ALT <500 IU/L. Patients with ALT ≥1000 had smaller bile duct diameter of 7 versus 10 mm (p < .001) but similar proportions of cholecystectomies. In the multivariate analysis age, maximal AST and maximal bilirubin were independent predictors of ALT >500. Maximal AST and bile duct diameter were independent predictors of ALT >1000. Conclusions: Approximately 8% of patients with CDL had markedly elevated ALT. These patients had smaller bile duct diameter. Pronounced ALT elevation is a part of the clinical spectrum of CDL.
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Affiliation(s)
- Helgi K Björnsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland , Reykjavik , Iceland.,Faculty of Medicine, University of Iceland , Reykjavik , Iceland
| | - Einar S Björnsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland , Reykjavik , Iceland.,Faculty of Medicine, University of Iceland , Reykjavik , Iceland
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Ham JH, Yu JS, Choi JM, Cho ES, Kim JH, Chung JJ. Peri-ampullary duodenal diverticulum: effect on extrahepatic bile duct dilatation after cholecystectomy. Clin Radiol 2019; 74:735.e15-735.e22. [PMID: 31256908 DOI: 10.1016/j.crad.2019.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/31/2019] [Indexed: 01/05/2023]
Abstract
AIM To investigate the effect of peri-ampullary duodenal diverticula (PAD) on extrahepatic bile duct (EHBD) dilatation before and after cholecystectomy. MATERIALS AND METHODS During a 5-year period, a total of 860 consecutive patients with prior cholecystectomy were examined using abdominal computed tomography (CT). After exclusion of those with other obstructive EHBD lesions, 61 patients with PAD were recruited for evaluation of EHBD dilatation before and after cholecystectomy and were compared with a randomly sampled control group (n=113) without PAD. EHBD diameter was measured on coronal reconstruction CT using electronic callipers on the picture archiving and communication system monitors by two reviewers in consensus. RESULTS There was no significant difference in EHBD diameter between PAD and non-PAD groups (8.2±2.8 versus 7.8±2.3 mm; p=0.276) before cholecystectomy. Compared with preoperative diameter, EHBD was significantly dilated after cholecystectomy (7.9±2.5 versus 9.8±3.4 mm, p<0.001), regardless of the presence of PAD; the degree of change was more prominent in the PAD group than in the non-PAD group (3.3±2.4 versus 1.1±1.6 mm; p<0.001) after surgery. The size of PAD did not affect the degree of EHBD dilatation after cholecystectomy (p=0.522). In the non-PAD group, the degree of EHBD dilatation was positively correlated with the follow-up interval after cholecystectomy (r=0.298; p=0.002), while the PAD group showed no significant correlation (r=-0.036; p=0.797). In patients with ≥2 mm postoperative EHBD dilatation, PAD incidence was higher than that in other patients (odds ratio, 8.739; p<0.001). CONCLUSION Regardless of their size or postoperative follow-up duration, PAD induce marked post-cholecystectomy biliary dilatation.
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Affiliation(s)
- J H Ham
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - J-S Yu
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea.
| | - J M Choi
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - E-S Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - J H Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - J-J Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
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D'Souza LS, Buscaglia JM. The Use of Endoscopic Ultrasound in the Evaluation of Unexplained Biliary Dilation. Gastrointest Endosc Clin N Am 2019; 29:161-171. [PMID: 30846146 DOI: 10.1016/j.giec.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Isolated biliary dilation, as an incidental diagnosis, is increasing owing to an increase in the use of noninvasive abdominal imaging and poses a diagnostic challenge to physicians especially when further noninvasive diagnostic testing fails to reveal an etiology. This article reviews available data describing the natural history of this clinical scenario and the impact of endoscopic ultrasound examination in the evaluation of unexplained dilation of the common bile duct.
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Affiliation(s)
- Lionel S D'Souza
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, 101 Nicolls Road HSC Level 17, Room 60, Stony Brook, NY 11794, USA.
| | - Jonathan M Buscaglia
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, 101 Nicolls Road HSC Level 17, Room 60, Stony Brook, NY 11794, USA
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Yu CY, Roth N, Jani N, Cho J, Van Dam J, Selby R, Buxbaum J. Dynamic liver test patterns do not predict bile duct stones. Surg Endosc 2019; 33:3300-3313. [PMID: 30911921 DOI: 10.1007/s00464-018-06620-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Numerous models have been developed to predict choledocholithiasis. Recent work has shown that these algorithms perform suboptimally. Identification of clinical predictors with high positive and negative predictive value would minimize adverse events associated with unnecessary diagnostic endoscopic retrograde cholangiopancreatography (ERCP) while limiting the use of expensive tests including magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) for indeterminate cases. METHODS Consecutive unique inpatients who received their first ERCP at Los Angeles County Medical Center between January 2010 and November 2016 for suspected bile duct stones were reviewed. The primary outcome was the proportion of patients with specific combinations of liver enzyme patterns, transabdominal ultrasound, and clinical features who had stones confirmed on ERCP. As a secondary outcome, we assessed the performance of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification algorithm in our population. RESULTS Of the 604 included patients, bile duct stones were confirmed in 410 (67.9%). Detailed assessment of liver enzyme patterns alone and in combination with clinical features and imaging findings yielded no highly predictive algorithms. Additionally, the ASGE high-risk criterion had a positive predictive value of only 68% for stones. For the 236 patients for whom MRCP was performed, this imaging modality was shown to have highest predictive value for the presence of stones on ERCP. CONCLUSION Exhaustive exploration of various threshold values and dynamic patterns of liver enzymes combined with clinical features and basic imaging findings did not reveal an algorithm to accurately predict the presence of stones on ERCP. The ASGE risk stratification criteria were also insensitive in our population. Though desirable, there may be no "perfect" combination of clinical features that correlate with persistent bile duct stones. MRCP or EUS may be considered to avoid unnecessary ERCP and associated complications.
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Affiliation(s)
- Chung Yao Yu
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Nitzan Roth
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Niraj Jani
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Jaehoon Cho
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Jacques Van Dam
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Rick Selby
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - James Buxbaum
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA.
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Chamadol N, Khuntikeo N, Thinkhamrop B, Thinkhamrop K, Suwannatrai AT, Kelly M, Promthet S. Association between periductal fibrosis and bile duct dilatation among a population at high risk of cholangiocarcinoma: a cross-sectional study of cholangiocarcinoma screening in Northeast Thailand. BMJ Open 2019; 9:e023217. [PMID: 30898798 PMCID: PMC6475358 DOI: 10.1136/bmjopen-2018-023217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess associations between periductal fibrosis (PDF) and bile duct dilatation (BDD) in ultrasonography (US) screening of population at risk of cholangiocarcinoma (CCA) due to residence in an endemic area for Opisthorchis viverrini. CCA survival rates are low, and early identification of risk factors is essential. BDD is one symptom that can identify patients at risk of CCA. Detection of PDF by US can also identify at-risk patients, at an earlier stage of CCA development. Identification of association between PDF and BDD will inform screening practices for CCA risk, by increasing the viability of PDF screening for CCA risk. SETTING Nine tertiary care hospitals in Northeast Thailand. DESIGN Cross-sectional study. PARTICIPANTS Study subjects in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Northeast Thailand. CASCAP inclusion criteria are all residents of Northeast Thailand aged ≥40 years. Participants are recruited through CCA screening centres and through primary healthcare units. So far, 394 026 have been enrolled. METHODS PDF and BDD were identified through US. PDF was categorised into three groups, PDF1, 2 and 3, depending on their high echo locality in the peripheral, segmental and main bile duct, respectively. Associations between PDF and BDD were determined by adjusted OR and 95% CI using multiple logistic regression. RESULTS BDD was found in 6.6% of PDF3, 1.7% of PDF2 and 1.4% of PDF1 cases. Among PDF cases, especially in PDF3, BDD was found in men more than in women (8.9% and 4.6%, respectively). Compared with non-PDF, the association between PDF3 and BDD was highly significant (adjusted OR=5.74, 95% CI 4.57 to 7.21, p<0.001). CONCLUSIONS Our findings reveal that there is a relationship between PDF and BDD, which is associated with CCA. Therefore, PDF can also be an indicator for suspected CCA diagnosis through US.
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Affiliation(s)
- Nittaya Chamadol
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narong Khuntikeo
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bandit Thinkhamrop
- Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand
- Epidemiology and Biostatistics Section, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kavin Thinkhamrop
- Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Apiporn T Suwannatrai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Supannee Promthet
- Epidemiology and Biostatistics Section, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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22
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Common bile duct dilation after bariatric surgery. Surg Endosc 2018; 33:2531-2538. [DOI: 10.1007/s00464-018-6546-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022]
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Moharamzad Y, Abbasi S, Sanei Taheri M, Faghihi Langroudi T. Association between common bile duct diameter and abdominal aorta calcium score. Abdom Radiol (NY) 2018; 43:2097-2102. [PMID: 29214447 DOI: 10.1007/s00261-017-1431-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE There is evidence of association between aging and increase in the normal upper limit of the common bile duct (CBD) diameter. As aging is a documented risk factor for atherosclerosis, and the possible effect that atherosclerosis can have on the CBD diameter via affecting its smooth muscle contractility and blood flow, we decided to determine the association between CBD diameter and atherosclerosis in the abdominal aorta (AA). METHODS A total of 99 asymptomatic patients (53 males and 46 females; age range of 18-88 years) without history of cholecystectomy who underwent abdominal contrast-enhanced CT scan were included. The CBD diameter was measured. The atherosclerosis of AA was quantified by Agatston score. RESULTS Mean (± SD) CBD diameter was 6.14 (± 1.95) mm; range = 2.4-12.7 mm. Agatston score was 0 in 59 patients. In the remaining 40 patients, median (interquartile range, IQR) Agatston score was 497.5 (2026.3). Mean (± SD) CBD diameter in patients with Agatston score > 0 was 7.39 (± 2.07) mm compared to 5.29 (± 1.32) mm in patients without calcification plaque (P < 0.001). A moderate correlation was seen between CBD diameter and Agatston score (ρ = 0.43; P = 0.005). CONCLUSION Although the exact cause of increased CBD diameter with advancing age is not understood, a general atherosclerotic process which occurs with aging may affect smooth muscle of the CBD. Whether an upper limit for normal CBD should be defined or not when evaluating dilated CBD for patients with subclinical or clinical atherosclerosis needs further studies.
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Affiliation(s)
- Yashar Moharamzad
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
| | - Sahar Abbasi
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran.
| | - Taraneh Faghihi Langroudi
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tajrish Sq, Tehran, 1445613131, Iran
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Abstract
OBJECTIVE The normal diameter of the extrahepatic bile duct (EHD) in children has been poorly studied. Prior studies have enrolled small subject numbers, have studied only specific pediatric age groups, or have potential bias due to loosely defined exclusion criteria. We sought to establish parameters for the normal diameter of the EHD in children from birth to late adolescence, including premature infants. METHODS A 12½-month institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective chart review of all transabdominal ultrasounds performed on children (younger than 18 years) was conducted at a single pediatric tertiary referral center. Exclusion criteria included a past medical history of any pancreaticobiliary or hepatology disorder. New abnormal findings related to the liver, biliary system, or pancreas were also excluded. Recorded EHD measurements from review of the radiology reports were compiled. Estimated mean and 95% prediction intervals of EHD were calculated and reported for 6 nonoverlapping pediatric age groups. RESULTS A total of 1016 ultrasounds on unique patients were included within the study. Estimated mean values and calculated 95% prediction intervals (in parentheses) for the diameter of the EHD were prematurity, 0.7 (0.3-1.7) mm; 0 to 2 months, 1.0 (0.4-2.3) mm; 3 to 11 months, 1.2 (0.5-2.9) mm; 1 to 4 years, 1.4 (0.6-3.3) mm; 5 to 12 years, 1.9 (0.8-4.3) mm; 13 to 17 years, 2.3 (1.0-5.2) mm. CONCLUSIONS Our derived data of normal predicted parameters of the EHD diameter in children of all age groups will help guide clinicians in identifying those patients outside the norm that may benefit from additional testing.
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Huh CW, Jang SI, Lim BJ, Kim HW, Kim JK, Park JS, Kim JK, Lee SJ, Lee DK. Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis: Prospective comparative study. Medicine (Baltimore) 2016; 95:e5176. [PMID: 27759652 PMCID: PMC5079336 DOI: 10.1097/md.0000000000005176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400 IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.
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Affiliation(s)
- Cheal Wung Huh
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine Department of Medicine, The Graduate School of Yonsei University Seoul Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine Department of Pathology Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Hu KC, Chu CH, Wang HY, Chang WH, Lin SC, Liu CC, Liao WC, Liu CJ, Wu MS, Shih SC. How Does Aging Affect Presentation and Management of Biliary Stones? J Am Geriatr Soc 2016; 64:2330-2335. [PMID: 27676699 DOI: 10.1111/jgs.14481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Common bile duct (CBD) stones are common in elderly adults, but the effect of aging on the presentation of CBD stones remains to be evaluated. Recent studies have demonstrated that the clinical presentation of CBD stones may vary with age. Younger adults may present with classical biliary colic symptoms, whereas elderly adults may have no unapparent clinical features. Younger adults with CBD stones were significantly more likely to have abnormal liver function tests than those without. The sensitivity and accuracy of transabdominal ultrasound scans in screening for CBD stones increases with age. Antibiotic agents should be promptly administered to individuals with CBD stones complicated by cholangitis, but the effects of pharmacotherapy on renal function should be considered in elderly adults. Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be first-line treatment for CBD stones, and endoscopic biliary sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) along with ERCP is an adequate biliary drainage method in individuals with CBD stones. EPBD has a lower bleeding risk but higher post-ERCP risk of pancreatitis than EST. Longer-duration (>1 minute) EPBD may be preferred over EST because it is associated with a comparable risk of pancreatitis but a lower rate of overall complications, although recurrent cholangitis or unfavorable outcomes will increase during CBD dilation or in the presence of residual CBD stones.
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Affiliation(s)
- Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan
| | - Wen-Hsiung Chang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan
| | - Shee-Chan Lin
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan
| | - Chuan-Chuan Liu
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medical, Nursing, and Management College, Taipei, Taiwan.,MacKay Medical College, Taipei, Taiwan
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Hu KC, Chu CH, Wang HY, Chang WH, Lin SC, Liu CC, Liao WC, Liu CJ, Wu MS, Shih SC. How Does Aging Affect Presentation and Management of Biliary Stones? J Am Geriatr Soc 2016. [DOI: doi.org/10.1111/jgs.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Kuang-Chun Hu
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- Healthy Evaluation Center; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
- Graduate Institute of Clinical Medicine; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
| | - Wen-Hsiung Chang
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
| | - Shee-Chan Lin
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
| | - Chuan-Chuan Liu
- Healthy Evaluation Center; MacKay Memorial Hospital; Taipei Taiwan
| | - Wei-Chih Liao
- Department of Internal Medicine; National Taiwan University Hospital; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine; College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine; College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology; Department of Internal Medicine; MacKay Memorial Hospital; Taipei Taiwan
- Healthy Evaluation Center; MacKay Memorial Hospital; Taipei Taiwan
- MacKay Medical, Nursing, and Management College; Taipei Taiwan
- MacKay Medical College; Taipei Taiwan
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CT evaluation of common duct dilation after cholecystectomy and with advancing age. ACTA ACUST UNITED AC 2016; 40:1581-6. [PMID: 25421790 DOI: 10.1007/s00261-014-0308-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate common duct (CD) dilation by computed tomography (CT) in patients with intact gallbladders and diameter change over time in remote and interval cholecystectomy patients, frequency of visualization of the CD, and its relationship to age. METHODS This IRB-approved retrospective study evaluated baseline CD diameter, intrahepatic biliary dilation, and interval duct diameter change in patients with CTs ≥ 2 years apart (n = 324), in block-randomized order by two blinded board-certified radiologists. 272 patients were divided into three groups: (1) prior cholecystectomy before the first CT, (2) cholecystectomy between the first and last CTs, and (3) no cholecystectomy. A subset of 191 nonoperated patients was evaluated for age-related dilation. RESULTS Group 1 ducts were significantly larger than the other groups at both baseline and follow-up CTs (p < 0.001). Group 2 showed a greater increase in duct size than the other groups at follow-up (p < 0.001). The CD was measurable in 89% of the CT studies. In nonoperated patients, there was a statistically significant correlation between CD size and increasing age (p < 0.001), although the CD size remained within normal size limits. CONCLUSION Remote cholecystectomy patients have larger CD diameters than the nonoperated and interval cholecystectomy groups. Greater increase in ductal diameter occurred between studies in the interval cholecystectomy patients, suggesting that dilation occurs after cholecystectomy. Also, the CD dilates slightly with age in nonoperated patients.
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Tamir S, Braun M, Issachar A, Bachar GN, Benjaminov O. Yield of magnetic resonance cholangiopancreatography for the investigation of bile duct dilatation in asymptomatic patients. United European Gastroenterol J 2016; 5:408-414. [PMID: 28507753 DOI: 10.1177/2050640616652317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Biliary dilatation in the asymptomatic patient is a frequent incidental finding in the work-up for which there are no current guidelines. OBJECTIVES The purpose of this study was to determine the yield of magnetic resonance cholangiopancreatography (MRCP) in asymptomatic patients with an incidental finding of biliary duct dilatation. METHODS The study included 68 consecutive patients for evaluation of biliary duct dilatation found incidentally on computed tomography (CT) or ultrasound (US). MRCP scans were reviewed, and data were retrospectively collected on demographics and laboratory work-up. Patients were divided by the presence of a significant or non-significant MRCP findings explaining the biliary duct dilatation and compared for normal or abnormal liver function. RESULTS Liver function was normal in 47 patients and abnormal in 21 patients. MRCP identified the cause of the bile duct dilatation in 41 patients (60.3%). Rates of insignificant causes were 51% in the normal-liver-function group and 7% in the abnormal-function group. Corresponding rates of significant causes were 27.7% and 61.9% (p = 0.007). CONCLUSIONS MRCP is a valuable tool in the work-up of biliary duct dilatation. Although significantly more significant causes of bile dilatation are identified in patients with abnormal liver function, almost one-third of patients with normal liver function need further work-up. This has important implications for establishing criteria for the use of MRCP in asymptomatic patients with biliary dilatation.
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Lal N, Mehra S, Lal V. Ultrasonographic measurement of normal common bile duct diameter and its correlation with age, sex and anthropometry. J Clin Diagn Res 2014; 8:AC01-4. [PMID: 25653927 DOI: 10.7860/jcdr/2014/8738.5232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ultrasonography is the diagnostic method of choice for visualization and rational work-up of abdominal organs. The dilatation of the common bile duct helps distinguish obstructive from non-obstructive causes of jaundice. Availability of normal measurements of the common bile duct is therefore important. There exists significant variations in the anthropometric features of various populations, regions and races. AIM Study was conducted to obtain data on sonographically measured diameters of common bile duct in a series of normal Rajasthani population and to measure its correlation with age, sex and anthropometry. SETTING AND DESIGN Cross-sectional hospital-based study conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, India. MATERIALS AND METHODS Study included 200 participants with equal proportion belonging to either sex. Common bile duct was measured at three locations- at the porta hepatis, in the most distal aspect of head of pancreas and mid-way between these points. Anthropometric measurements including height, weight, chest circumference, circumference at transpyloric plane, circumference at umbilicus and circumference at hip were obtained using standard procedures. STATISTICAL ANALYSIS Univariable analysis with measures of frequency and standard deviation and bivariable analysis using correlation. RESULTS Mean age of study subjects was 34.5 years (Range 18-85 years). Mean diameters of the common bile duct in the three locations were: proximal, 4.0 mm (SD 1.02 mm); middle, 4.1 mm (SD 1.01 mm); and distal, 4.2 mm (SD 1.01 mm) and overall mean for all measures 4.1 mm (SD 1.01 mm). Average diameter ranged from 2.0 mm to 7.9 mm, with 95 percent of the subjects having a diameter of less than 6 mm. We observed a statistically significant relation of common bile duct with age, along with a linear trend. There was no statistically significant difference in common bile duct diameter between male and female subjects. The diameter did not show any statistically significant correlation with any of the anthropometric measurements. CONCLUSION Our study reported the upper limit of normality as 7.9 mm. The diameter increased progressively from 3.9 mm among those aged 18-25 years to 4.7 mm among those in the age group more than 55 years. This was found to be statistically significant. Ductal diameters beyond these limits should prompt the need for further investigations.
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Affiliation(s)
- Nidhi Lal
- Demonstrator, Department of Anatomy, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Simmi Mehra
- Associate Professor, Department of Anatomy, Mahatma Gandhi Medical College and Hospital , Jaipur, India
| | - Vivek Lal
- Regional Medical Advisor (East), GLRA-India
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Hu KC, Wang HY, Chang WH, Chu CH, Lin SC, Liu CJ, Wu MS, Shih SC. Clinical presentations of patients from different age cohorts with biliary tract stone diseases. J Gastroenterol Hepatol 2014; 29:1614-9. [PMID: 24628028 DOI: 10.1111/jgh.12581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM The role of clinical symptoms, transabdominal ultrasound scan (USS), and liver function tests (LFTs) in evaluating common bile duct (CBD) stones in patients suspected to have pancreatobiliary disease has been studied. However, it is unclear whether these predictive models are useful in different age cohorts. The aim of this study is to investigate the clinical presentations from different age cohorts with and without CBD stones. METHODS Four hundred and forty-three patients with pancreatobiliary diseases were divided into cohorts according to decades as follows: young (Y, 18-64 years old, n = 143), young-old (YO, 65-74 years old, n = 168), old-old (OO, 75-84 years old, n = 97), and very old (VO, ≥ 85 years old, n = 35). The clinical symptoms, LFTs, and USS findings were demonstrated and compared among patients. RESULTS Y- and YO-group patients were more likely to develop symptoms such as biliary colic in the presence of CBD stones. The proportion of abnormal serum aspartate aminotransferase and alanine aminotransferase were significantly greater in Y-, YO-, and OO-group patients with than in those without CBD stones. Sensitivity of USS for CBD stones in Y: 0.15; YO: 0.45; OO: 0.57; and VO: 0.68. Accuracy of USS for detected CBD stone in Y: 48%; YO: 62.5%; OO: 70.1%; and VO: 71.4%. CONCLUSION Combined evaluation of clinical symptoms, biochemical and USS findings may help predict the presence of CBD stones. In Y, YO, and OO patients with CBD stones, the incidences of abnormal LFTs were higher. The sensitivity and accuracy of USS in detecting CBD stones were increased according to age.
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Affiliation(s)
- Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, New Taipei, Taiwan; Healthy Evaluation Center, Mackay Memorial Hospital, New Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, New Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, New Taipei, Taiwan
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Ketamine-related cholangiopathy: a retrospective study on clinical and imaging findings. ACTA ACUST UNITED AC 2014; 39:1241-6. [DOI: 10.1007/s00261-014-0173-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Planells Roig M, Ponce Villar Ú, Peiró Monzó F, Coret Franco A, Orozco Gil N, Bañuls Matoses Á, Sanchez Aparisi E, Marti Gonzalez L, Caro Martínez F. Biliary Pancreatitis. Liver Function Tests and Common Biliopancreatic Channel Kinetics--Biliopancreatic Reflux. Cir Esp 2013; 93:326-33. [PMID: 24041581 DOI: 10.1016/j.ciresp.2013.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 04/06/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG). PATIENTS AND METHODS Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P). LFT analysis between A and P were analysed between groups with respect to BPR, time interval to cholecystectomy within the same group and by determination of observed value/maximum normal value ratio (OV/MNV). RESULTS BPR incidence was 38.3% in BP in comparison with 5% in CG (p=0.0001) it was independent from interval time to cholecystectomy, in contrast with Odditis, suggesting an anatomical condition for CCBP and a functional one for Odditis. LFT analysis showed no differences in relation to BPR incidence. LFT excluding AP and GGT returned to normal values with significant differences in OV/MNV when BPR was present which points to an increased cholestasis in BPR group. US dilatation of CBD was noted in 10.3% and was associated to CCBP. CONCLUSIONS BPR in BP increases cholestasis and contributes to confusion in the estimation of common bile duct stones increasing ERCP-EE rates. US and biochemical markers of CBDS show a low specificity due to BPR-CCBP which suggests that MRI-cholangiography is a mandatory exploration before ERCP-EE examination.
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Affiliation(s)
- Manuel Planells Roig
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía, Hospital Francisco de Borja, Gandía, Valencia, España.
| | | | - Fabián Peiró Monzó
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía, Hospital Francisco de Borja, Gandía, Valencia, España
| | - Alba Coret Franco
- Servicio de Cirugía, Hospital Francisco de Borja, Gandía, Valencia, España
| | - Natalia Orozco Gil
- Servicio de Cirugía, Hospital Francisco de Borja, Gandía, Valencia, España
| | | | | | - Lidia Marti Gonzalez
- Servicio de Gastroenterología, Hospital Francisco de Borja, Gandía, Valencia, España
| | - Federico Caro Martínez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Francisco de Borja, Gandia, Valencia, España
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Hu K, Wang H, Chang W, Chu C, Lin S, Liu C, Wu M, Shih S. Transabdominal Ultrasound Finding and Acute Hepatocellular Injury in Different Cohorts of Elderly Adults with and without Common Bile Duct Stones. J Am Geriatr Soc 2013; 61:1221-4. [DOI: 10.1111/jgs.12346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kuang‐Chun Hu
- Division of Gastroenterology Department of Internal Medicine Healthy Evaluation Center Mackay Memorial Hospital Taipei Taiwan
- Graduate Institute of Clinical Medicine College of Medicine National Taiwan University Taipei Taiwan
| | - Horng‐Yuan Wang
- Mackay Medicine, Nursing and Management College Taipei Taiwan
- Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan
| | - Wen‐Hsiung Chang
- Mackay Medicine, Nursing and Management College Taipei Taiwan
- Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan
| | - Cheng‐Hsin Chu
- Mackay Medicine, Nursing and Management College Taipei Taiwan
- Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan
| | - Shee‐Chan Lin
- Mackay Medicine, Nursing and Management College Taipei Taiwan
- Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital Taipei Taiwan
| | - Chun‐Jen Liu
- Graduate Institute of Clinical Medicine College of Medicine National Taiwan University Taipei Taiwan
| | - Ming‐Shiang Wu
- Graduate Institute of Clinical Medicine College of Medicine National Taiwan University Taipei Taiwan
| | - Shou‐Chuan Shih
- Division of Gastroenterology Department of Internal Medicine Healthy Evaluation Center Mackay Memorial Hospital Taipei Taiwan
- Mackay Medicine, Nursing and Management College Taipei Taiwan
- Mackay Medical College Taipei Taiwan
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Landry D, Tang A, Murphy-Lavallée J, Lepanto L, Billiard JS, Olivié D, Sylvestre MP. Dilatation of the bile duct in patients after cholecystectomy: a retrospective study. Can Assoc Radiol J 2013; 65:29-34. [PMID: 23453523 DOI: 10.1016/j.carj.2012.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/02/2012] [Accepted: 09/22/2012] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Retrospective assessment of impact of cholecystectomy, age, and sex on bile duct (BD) diameter. MATERIALS AND METHODS We retrospectively reviewed abdominal contrast-enhanced multidetector computed tomography and laboratory reports of 290 consecutive patients (119 men; mean age, 55.9 years) who presented without cholestasis to the emergency department of our institution between June 2009 and August 2010. BD diameters were measured in 3 locations, by 2 independent observers, twice, at 1-month intervals. Reproducibility and agreement were evaluated by intraclass correlation coefficients and Bland-Altman analyses. The effects of cholecystectomy, age, and sex on BD diameter were analysed with linear mixed models. RESULTS BD diameter inter-reader reproducibility and agreement were excellent at the level of the right hepatic artery (intraclass correlation coefficient, 0.94). Sixty-one patients (21.0%) had a history of cholecystectomy. Among them, the 95th percentile of BD diameters at hepatic artery level was 7.9 mm (<50 years) and 12.3 mm (≥50 years). Among those without cholecystectomy, BD diameter was 6.2 mm (<50 years) and 7.7 mm (≥50 years). Cholecystectomy was associated with significantly larger BD diameters in both age groups (P < .001). Older age was associated with larger BD diameters (P = .004). Sex had no impact on BD diameter (P = .842). CONCLUSION Patients after cholecystectomy may present with an enlarged BD unrelated to cholestasis. The BD diameter increases with age. Clinicians should rely on cholecystectomy status, age, and laboratory results to determine needs of further investigation.
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Affiliation(s)
- David Landry
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Jessica Murphy-Lavallée
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada.
| | - Luigi Lepanto
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, University of Montréal and CRCHUM, Hôpital Saint-Luc, Montréal, Québec, Canada
| | - Marie-Pierre Sylvestre
- Biostatistics Services, University of Montreal Hospital Research Center (CRCHUM), Centre de recherche du CHUM, Montréal, Québec, Canada
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El-Hayek K, Timratana P, Meranda J, Shimizu H, Eldar S, Chand B. Post Roux-en-Y gastric bypass biliary dilation: natural process or significant entity? J Gastrointest Surg 2012; 16:2185-9. [PMID: 23099735 DOI: 10.1007/s11605-012-2058-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/11/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Changes in the biliary system after gastric bypass are not well defined. Dilation may be normal or due to biliary tract pathology. The purpose of this study is to review patients who underwent imaging of their biliary system both before and after Roux-en-Y gastric bypass in an effort to elucidate the effect this operation has on hepatic duct diameter. METHODS Patients with imaging both before and at least 3 months after gastric bypass were analyzed. Hepatic duct was measured at the level of the porta hepatis to determine interval changes. RESULTS Thirty-three patients had postoperative imaging at least 3 months following gastric bypass. Mean hepatic duct diameter was 5.2 ± 2 and 7.1 ± 2.6 mm preoperatively and postoperatively, respectively (p < 0.01). Patients with prior cholecystectomy had hepatic duct diameters of 7.9 ± 1.3 and 9.5 ± 3.5 mm preoperatively and postoperatively, respectively (p = 0.3). Patients who had not previously undergone cholecystectomy had hepatic duct diameters of 4.3 ± 1.1 and 6.4 ± 1.8 mm preoperatively and postoperatively, respectively (p < 0.01). CONCLUSIONS Hepatic duct diameter increases after Roux-en-Y gastric bypass. A better understanding of this phenomenon may limit the need for further work-up in patients with incidentally detected biliary dilation.
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Affiliation(s)
- K El-Hayek
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography. Surg Endosc 2012; 27:303-7. [PMID: 22903627 DOI: 10.1007/s00464-012-2445-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 06/07/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Increased common bile duct (CBD) diameter has been attributed to aging and previous cholecystectomy. These relationships are, however, controversial and based mainly on old studies and methodologies. Our objective is to evaluate the relationship between age, cholecystectomy, and other clinical factors and CBD diameter, as measured by endoscopic ultrasound (EUS). METHODS We carried out a retrospective cohort study including patients who underwent EUS in our institution. Patients with an obstructing lesion of the bile ducts, previous sphincter manipulation, or insufficient data were excluded. CBD diameter was measured as a routine part of the examination, in the most distal extrapancreatic portion, between its two exterior margins. The patients were divided into five age groups. The mean CBD diameter in each group was calculated and compared with the other groups. Effects of cholecystectomy, gender, time from operation, and elevated liver enzymes were also evaluated. RESULTS Six hundred forty-seven patients were included in the study (66% women). Twenty-three percent were postcholecystectomy. There was no difference between the first three groups regarding CBD diameter, but it was significantly wider in groups 4 and 5 (p < 0.001). In all age groups, the postcholecystectomy patients had significantly wider CBD than those with an intact gallbladder (in all groups, p < 0.01). CONCLUSIONS This EUS study confirms that the CBD dilates significantly after the age of 70 years, but even in the most elderly patients, with an intact gallbladder, the normal CBD does not exceed 7.6 mm, thus a wider CBD warrants further investigation. The single additional factor contributing to dilatation of the CBD was cholecystectomy. A linear regression equation is proposed for the prediction of CBD diameter.
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Park SM, Kim WS, Bae IH, Kim JH, Ryu DH, Jang LC, Choi JW. Common bile duct dilatation after cholecystectomy: a one-year prospective study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:97-101. [PMID: 22880184 PMCID: PMC3412191 DOI: 10.4174/jkss.2012.83.2.97] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/20/2012] [Accepted: 05/31/2012] [Indexed: 01/29/2023]
Abstract
PURPOSE Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year. METHODS Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively. RESULTS The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after cholecystectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. CONCLUSION Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.
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Affiliation(s)
- Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
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Cheng Y, Lin Y, Xiong X, Wu S, Lu J, Cheng N. The human umbilical cord: A novel substitute for reconstruction of the extrahepatic bile duct. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Urquhart P, Speer T, Gibson R. Challenging clinical paradigms of common bile duct diameter. Gastrointest Endosc 2011; 74:378-9. [PMID: 21683353 DOI: 10.1016/j.gie.2011.03.1256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/30/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Paul Urquhart
- RoyalMelbourne Hospital Parkville, Victoria, Australia
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Abstract
Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigations in patients with incidentally identified modest ductal dilatation without symptoms or laboratory abnormalities. Additional investigations are more likely to identify clinically relevant findings in patients with more pronounced dilatation. EUS is highly accurate, low-invasive, and useful in this setting, whereas ERC should be reserved for cases likely to require therapeutic intervention.
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Abstract
Ultrasound is a pivotal study for evaluation of the biliary tree. In particular, the size of the extrahepatic bile duct is a critical measurement and has been a contentious issue since the early days of diagnostic ultrasound. This article reviews the history and ongoing issues regarding sonography of the normal-size duct and a variety of factors that may affect its size, including age, prior surgery, congenital abnormalities, anatomical variations, and medications. Other related sonographic issues are discussed including abnormal nondilated ducts and abnormal intraluminal contents such as sludge or air that make evaluation of the duct more difficult, particularly in patients with primary sclerosing cholangitis and prior liver transplantation. Ultimately, the luminal size of the extrahepatic duct should be considered as a single part of the entire assessment of the biliary tree that must also include the intrahepatic and pancreatic ducts, the pattern of dilatation (variable vs progressively dilated to a single point of obstruction), any wall thickening, intraluminal sludge, calculi or mass, and extraluminal compression. Clinical symptoms and abnormal laboratory values should prompt further evaluation despite a normal appearance of the bile duct, whereas pursuit of an isolated finding of an enlarged duct without supporting clinical data may not be warranted.
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Rezaee A, Narouie B, Ghasemi-Rad M, Nosair E, Mohebi F, Sharareh Sanei Sistani. Is Opioid Addiction a Sufficient Predicting Factor for Common Bile Duct Dilatation? A Sonographic Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479310366470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the absence of hepatobiliary symptoms, opioid consumption has been shown to cause dilatation of the common bile duct (CBD). The main objective of this study was to measure with sonography CBD diameters in opioid addicts as compared with nonaddicts. The research was done on 208 individuals; 104 were opioid addicts using various routes of administration (inhalation, oral, or intravenous), and 104 had no history of addiction (control group). All patients underwent abdominopelvic sonography, and the internal diameters of the proximal part of the CBD were recorded. The average CBD diameter in the control group was 4.13 ± 1.14 mm, which significantly increased to 8.16 ± 2.54 mm in the case group. A significant increase in the average diameter of CBD in the case group with the oral route was 10.7 ± 2.26 mm, compared with 7.5 ± 1.64 mm and 7.6 ± 3.05 mm, respectively, for those using inhalation and intravenous routes. The diameter of CBD was age dependent. The dilatation of the CBD detected by sonography occurring in opioid addicts in all age groups was attributed principally to the effect of opioids. Oral administration of opioid caused the highest dilatation effect on CBD.
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Affiliation(s)
- Ahmad Rezaee
- Zahedan University of Medical Sciences, Zahedan, Iran
| | - Behzad Narouie
- Ali-ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Iran,
| | | | - Emad Nosair
- University of Sharjah, Sharjah, United Arab Emirates
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Chawla S, Trick WE, Gilkey S, Attar BM. Does cholecystectomy status influence the common bile duct diameter? A matched-pair analysis. Dig Dis Sci 2010; 55:1155-60. [PMID: 19455421 DOI: 10.1007/s10620-009-0836-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/30/2009] [Indexed: 02/06/2023]
Abstract
The common bile duct (CBD) diameter is one factor that clinicians use when deciding on invasive evaluation for intra-ductal pathology, e.g., endoscopic retrograde cholangiopancreatography. Previous studies and gastrointestinal and radiological textbook authors report disparate interpretations. These inconsistent interpretations likely result from methodological limitations in prior studies. The purpose of this work is to primarily compare the CBD diameter among patients with and without prior cholecystectomy and secondarily to compare proximal and distal CBD measurements. Among 40 matched pairs, post-cholecystectomy patients had larger mean CBD diameters at proximal (7.0 vs. 5.4 mm; P < 0.001) and distal (5.9 vs. 4.6 mm; P < 0.001) sites. Post-cholecystectomy patients were also more likely to exceed the 6-mm cut point for proximal (80 vs. 28%; P < 0.001) or distal (58 vs. 20%; P = 0.003) measurements. Incidental radiographic detection of enlarged CBDs among post-cholecystectomy patients is common; therefore, clinicians should use clinical determinants to guide decisions about additional costly or potentially harmful evaluation for intraductal pathology.
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Affiliation(s)
- Saurabh Chawla
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, 1900 W Polk St., 15th Floor, Chicago, IL, 60612, USA.
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Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010; 71:1-9. [PMID: 20105473 DOI: 10.1016/j.gie.2009.09.041] [Citation(s) in RCA: 310] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/29/2009] [Indexed: 02/08/2023]
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Park JS, Lee DH, Jeong S, Cho SG. Determination of Diameter and Angulation of the Normal Common Bile Duct using Multidetector Computed Tomography. Gut Liver 2009; 3:306-10. [PMID: 20431765 PMCID: PMC2852735 DOI: 10.5009/gnl.2009.3.4.306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/20/2009] [Indexed: 12/27/2022] Open
Abstract
Background/Aims Common bile duct stones are associated with the extent of dilation of the common bile duct as well as its angulation. Multidetector computed tomography (MD CT) has a good resolution for the definition of the anatomical features of the common bile duct. Methods The multiplanar reformation images of 398 patients that underwent multidetector CT for the diagnosis of disorders not related to the bile duct were examined. The diameter and angulation were categorized by gender and age. Results The average diameter and angulation of the common bile duct was 6.7 mm and 132.6°. There was a statistically significant correlation between age and the common bile duct diameter. The Pearson correlation analysis for age and diameter resulted in a value of 0.415 (p<0.001). And the common bile duct (CBD) diameter in people older than 51 years of age showed a significant difference compared to the subjects younger than 50 years of age (p<0.01). However, the degree of angulation has no correlation with age. Conclusions We suggest that CBD diameters in patients more than 50 years of age can be more than 7 mm and be within normal limits.
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Affiliation(s)
- Jin-Seok Park
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Natural progression of biochemical markers of biliary tract obstruction in patients with gallstone pancreatitis. Gastroenterol Res Pract 2009; 2009:820749. [PMID: 19503827 PMCID: PMC2686090 DOI: 10.1155/2009/820749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 03/09/2009] [Accepted: 04/12/2009] [Indexed: 11/19/2022] Open
Abstract
The presenting pattern and natural progression of biochemical markers of biliary tract obstruction in patients with gallstone pancreatitis have not been elucidated. We analyzed serial values of bilirubin levels following admission to discharge in 143 patients. Ninety-four of patients demonstrated a Decrescendo (falling) pattern of bilirubin levels from admission until normalization at 21 hours (median). Forty-nine patients demonstrated a Crescendo-Decrescendo (initially rising) pattern with peak levels of bilirubin occurring at 39 hours after admission followed by a subsequent normalization after a median of 119 hours. Patients in the Decrescendo group were significantly younger (33 versus 41 years, P = .02) and more patients had experienced symptoms for greater than 48 hours (65% versus 47%, P = .05). Ten percent of patients in the Decrescendo group and 29% of patients in the Crescendo-Decrescendo group underwent ERCP (P = .02). Normalization of biochemical markers after ERCP was significantly delayed in both groups compared to no ERCP. Older patients present earlier, with higher bilirubin levels and normalize slower than younger patients, perhaps due to fibrosis of the ampulla and decreased compliance of the common bile duct. Patients who disobstruct spontaneously (90%) normalize quicker than patients undergoing ERCP.
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Roberts DN, Maple JT. The Role of Endoscopic Ultrasonography (EUS) and Endoscopic Retrograde Cholangiography (ERC) in Diagnosing Choledocholithiasis. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2009. [DOI: 10.1016/j.tgie.2009.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
OBJECTIVES To determine quantitative and qualitative image quality in patients undergoing magnetic resonance (MR) cholangiography at 3.0 Tesla (T) compared with 1.5 T. MATERIALS AND METHODS Fifty patients (30 women; mean age, 51 years) underwent MR cholangiography at 1.5 T; another 50 patients (25 women; mean age 51 years) were scanned at 3.0 T. MR sequence protocol consisted of breath-hold single-slice rapid acquisition with relaxation enhancement (RARE) and a respiratory-triggered 3D turbo spin echo (3D TSE) sequence. Maximum intensity projections were generated from the 3D TSE datasets. Contrast-to-noise ratio (CNR) measurements between the common bile duct (CBD), left and right intrahepatic duct (LHD, RHD), and periductal tissue were performed. Three radiologists assessed qualitatively the visibility of the CBD, LHD, and RHD and the overall diagnostic quality. RESULTS Mean gain in CNR at 3.0 T versus 1.5 T in all 3 locations ranged for the RARE sequence from 7.7% to 38.1% and for the 3D TSE from 0.5% to 26.1% (P > 0.05 for all differences). Qualitative analysis did not reveal any significant difference between the 2 field strengths (P > 0.05). CONCLUSIONS MR cholangiography at 3.0 T shows a trend toward higher CNR without improving image quality significantly.
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Affiliation(s)
- Sebastian T Schindera
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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