For biliary dilatation, a negative endosonography needs additional image studies in weight loss suggesting malignancy

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Hepatobiliary Medicine

Background:

• Biliary dilatation is a common finding that can indicate serious pancreatobiliary diseases.
• Endoscopic ultrasonography (EUS) is a valuable tool for investigating biliary dilatation of unknown origin.

Purpose of the Study:

• To evaluate the diagnostic accuracy and etiological yield of EUS in patients with biliary dilatation without clear findings on initial ultrasonography.
• To identify clinical factors associated with malignancy versus choledocholithiasis in patients undergoing EUS for biliary dilatation.

Main Methods:

• Retrospective review of 163 patients who underwent EUS for dilated common bile duct (CBD) without definitive ultrasonography findings.
• Analysis of clinical data including weight loss, abdominal pain, fever, and carbohydrate antigen 19-9 levels.
• Logistic regression to identify predictors of malignancy and choledocholithiasis.

Main Results:

• EUS demonstrated high overall accuracy (95.1%) for biliary dilatation causes.
• Accuracy varied by diagnosis: 100% for no pathology, 96.3% for ampullary cancer, 84.6% for pancreatic cancer, 40% for CBD cancer, and 92.6% for choledocholithiasis.
• EUS accuracy was lower in malignancy (86.7%) compared to other causes (98.3%), with missed cancers requiring further investigation.

Conclusions:

• EUS is highly accurate for diagnosing choledocholithiasis, particularly in patients presenting with fever.
• Negative EUS findings in patients with weight loss warrant additional imaging to rule out malignancy.
• EUS plays a crucial role in the etiological assessment of biliary dilatation, guiding further management.