Introduction The finding of dilated CBD or PD or both (double duct sign) on abdominal cross-sectional imaging (CT or MRI) in patients with normal LFTs frequently leads to further investigation by EUS if a clear cause is not demonstrated on imaging. There is limited literature on the yield of EUS in this setting.
Methods A retrospective review of our prospectively maintained EUS database was carried out to identify patients who underwent EUS for dilated duct(s), normal LFTs and non-diagnostic cross-sectional imaging between January 2007 and August 2011. Our aim was to evaluate the yield of EUS in this setting. Minimum follow up was for 12 months.
Results 83 patients (3% of pancreaticobiliary EUS procedures during this period) were identified. Mean age was 66.7 years (30 – 87). There was a female preponderance (73%). 40(48%) had dilated CBD only, 5(6%) had solitary PD dilatation and 38(46%) had both CBD and PD dilatation on prior imaging. EUS was concordant with prior imaging in 60(72%) patients and discordant in 23(28%) [partial agreement in 18, non-dilated ducts in 3 and different duct dilated in 2]. 16(19%) patients had a new finding on EUS [3 cbd stones, 3 cbd polyps, 4 microlithiasis, 1 ampullary adenoma, 3 chronic pancreatitis, 1 pancreatic duct adenocarcinoma (PDAC) and 1 portal vein compressing mid CBD]. Of these 11(13%) were felt to be the cause of duct dilatation. On subsequent MDT review, the PDAC was identified on the initial scan from the referring hospital. 45% (10/22) of males compared to 9.8% of (6/61) females had a new finding on EUS (p = 0.0008). Overall, more females had symptoms compared to males (p = 0.065). There was no significant association between symptoms and new finding on EUS (p = 0.24). 7(17.5%) of the isolated CBD dilatation, 3(60%) of the isolated PD dilatation and 1(2.5%) of the dilated CBD and PD had a causative diagnosis respectively. Follow up of patients with no cause of duct dilatation on EUS revealed that 18 patients (54.5%) in the dilated CBD cohort had prior cholecystectomy [one patient had peri-ampullary diverticulum and prior cholecystectomy] while 2 and 10 patients in the dilated CBD and PD cohort (n = 37) had ampullary stenosis and prior cholecystectomy respectively.
Conclusion Our study shows that EUS has a significant yield in individuals with unexplained duct dilatation and normal LFT (13% had a causative diagnosis). The yield was highest in isolated PD dilatation. A new finding was significantly more likely in men then women. EUS should ideally follow review of original cross sectional imaging by a HPB radiologist.
Disclosure of Interest None Declared.
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