Mo1313 A QUANTITIVE ASSESSMENT OF ENDOSCOPIC ULTRASOUND YIELD IN PATIENTS REFERRED FOR DILATED COMMON BILE DUCT WITH NORMAL LIVER FUNCTION TESTS

Abstract

Endoscopic ultrasound (EUS) has an established role in the diagnosis of pancreatic and biliary disease. CBD dilation is common amongst older people and those with previous cholecystectomy. Data are limited regarding the yield of EUS in patients with asymptomatic CBD dilation and normal LFTs. To determine the frequency and predictive factors of significant pathology in patients with CBD dilation and normal LFTs in whom EUS is requested. All patients referred to CHUM, a tertiary EUS referral center, between October 2000 and December 2016, for EUS for unexplained CBD dilatation (defined as CBD diameter ≥ 7mm at any place), with normal LFTs (AST, ALT, ALP, BILI) and no history of biliary sphincterotomy, were eligible for this retrospective study. EUS was performed using the linear echoendoscope (Pentax Medical, Melville NJ) by one of 2 experienced endosonographers. Data were extracted from a prospectively maintained database. Between 10/1/2000 and 12/31/2015, 29920 upper gastrointestinal EUS procedures were performed, 840/29920 (3%) for unexplained CBD dilation. 199/840 (24%) had normal LFTs, (99%) were Caucasian, 46% had abdominal pain, and 41% were post-cholecystectomy. EUS diagnosed CDL or sludge in 18/199 (9%) patients (7/18 had CBD sludge only). No other pathology was diagnosed. 15/18 [83%] CDL patients had an intact gallbladder, and all 15 had cholelithiasis. The frequency of CDL or sludge in post-cholecystectomy patients was only 3.7% (3/82); and none of these patients were younger than 69 years of age. Univariate, bivariate and multivariate logistic regression analyses showed no associations between EUS diagnosis of CDL or sludge and abdominal pain, other symptoms, sex, or race. Each additional year of age was associated with an increase in the risk of CDL or sludge by a factor of 1.05 (OR: 1,05; p = 0.034). In patients referred for EUS for CBD dilation and abnormal LFTs, the only significant pathology identified is CBD stones or sludge, and this almost exclusively in elderly patients with cholelithiasis. EUS should be avoided in patients with dilated bile ducts and normal LFTs – especially if under 65 years of age and post-cholecystectomy.