EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

[Guest guest]

EUS

Yield in Evaluating Biliary Dilatation in Patients with Normal Serum Liver Enzymes

Authors:

Malik, Shahid; Kaushik, Neeraj; Khalid, Asif; Bauer,

Kathy; Brody, Debra; Slivka,

Adam; McGrath,

Source: Digestive Diseases

and Sciences, Volume 52, Number 2, February 2007

Abstract:

The finding of common bile duct (CBD) dilatation on

abdominal imaging frequently results in additional testing. It

has been our impression that endoscopic ultrasound

(EUS) evaluation of a dilated CBD is a low-yield examination in the setting of

normal serum liver enzymes. We therefore sought to

evaluate the EUS yield in evaluating CBD dilatation in patients with normal as

compared to elevated serum liver enzymes. A

retrospective review was performed to identify patients referred for EUS

evaluation of a dilated CBD in the absence of obvious pathology on prior

imaging. Charts were reviewed for patient symptoms,

presence of elevated serum liver enzymes, imaging studies before EUS, and EUS

findings. Exclusion criteria included clinical

jaundice, known biliary stricture, mass lesion or stone, and previously sphincterotomy and/or stent placement. Forty-seven

patients were identified: 32 with normal and 15 with elevated serum liver

enzymes. There was no difference in mean CBD diameter between

these two groups (8.51 vs. 8.79 mm, p=0.854). Of the entire group, 15 patients had undergone prior

magnetic resonance cholangiopancreatography (MRCP);

an additional 7 patients had undergone prior endoscopic

retrograde cholangiopancreatography (ERCP). EUS findings to explain CBD dilatation were found more

commonly in patients with elevated compared with normal serum liver enzymes

(53% vs. 6%, p=0.001). Periampullary diverticula and choledocholithiasis

were the most common findings; of 32 patients with normal serum liver enzymes,

one periampullary diverticulum

and one CBD stone were found, respectively. The CBD

stone had been missed by prior MRCP examination. Of 15

patients with elevated serum liver enzymes, there were 3 cases of choledocholithiasis, 4 periampullary

diverticula, and 1 ampullary

tumor. EUS should be the test of choice for further

evaluation of CBD dilatation when index imaging is normal. Although

the EUS yield is low in cases of biliary dilatation in the setting of normal

serum liver enzymes, its preferential use would potentially avoid unnecessary

MRCP and ERCP.

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas