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Common bile duct dilation (ie, ≥ 7 mm on ultrasonography or ≥ 10 mm on CT) with clinical or biochemical features of obstruction warrants further investigation. ERCP is the initial choice if there are signs of ascending cholangitis.
Dilated bile ducts can be seen on various imaging studies like ultrasound, CT and MRI. There are many causes, some of which can be benign and ignored while others can be life threatening and an emergency. Imaging tests and some more invasive procedures can help sort out the possibilities.
A dilated common bile duct can indicate various underlying health conditions, ranging from gallstones to more serious issues like cancer. Recognizing symptoms such as jaundice, abdominal pain, and changes in stool color is crucial for early detection.
For a patient with potential incidental bile duct dilation, there are 4 general clinical decision-making pathways, as follows (Figure 1)1,3: • Common bile duct dilation (ie, ≥ 7 mm on ultra-sonography or ≥ 10 mm on CT) with clinical or biochemical features of obstruction warrants fur-ther investigation. ERCP is the initial choice if
Coexisting CBD and intrahepatic bile duct dilation, age, and jaundice were found to be indicators of pathologic lesions. Dilation of both the CBD and pancreatic duct was suggestive of pancreatic disease, especially pancreatic malignancy in the setting of obstructive jaundice.
Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state.
Biliary duct dilatation is a common finding in clinical practice and is often incidental. In the absence of clinical symptoms or elevated levels on liver function tests (LFTs), a dilated bile duct is unlikely to imply biliary obstruction.
Median value of serum total bilirubin, serum CA 19.9 along with median diameter of common bile duct on imaging (trans abdominal ultrasound, MRCP, CECT abdomen or the highest diameter of either CT or MRCP) were significantly higher in the group with positive diagnosis on EUS (Table 3).
EUS combines endoscopy with real-time and high-resolution ultrasound providing excellent sonographic visualization of the extrahepatic biliary tree without interference of bowel gas, due to its ability to place the transducer in close proximity to the extrahepatic bile duct.
Endoscopic ultrasound (EUS) is important for the evaluation of patients with common bile duct (CBD) dilation. The purpose of this study was to evaluate the diagnostic performance of EUS for CBD dilation in patients with negative initial studies.