Width Of Common Bile Duct Research Articles

The Diagnostic Value of GGT-Based Biochemical Indicators for Choledocholithiasis with Negative Imaging Results of Magnetic Resonance Cholangiopancreatography.

To reveal the relationship between a group of preoperative biochemical indicators such as GGT, ALP, ALT, AST, TB, and DB and the occurrence of common bile duct stones in patients with negative results of magnetic resonance cholangiopancreatography, a retrospective diagnostic accuracy clinical test is conducted in this study. In order to reduce the missed diagnosis rate of choledocholithiasis and perform more accurate common bile duct exploration, 466 patients who underwent surgical treatment of cholelithiasis from January 2014 to December 2015 have been analyzed retrospectively. Firstly, the confounding factors are corrected through Binary Logistic regression. Then, the diagnostic efficacy of each indicator is measured by the ROC curve among different types of patients. In all patients, the top three individual indicators with the greatest AUC curve area for predicting common bile duct stones can be observed from the results of MRCP, γ-glutamyl transpeptidase, and alkaline phosphatase. Besides, the diagnostic efficiency of the comprehensive evaluation is higher than that of all individual indicators. For MRCP-negative patients, the top three largest AUC curve area of the diagnostic efficacy for choledocholithiasis were GGT, ALP, and DB. For patients who have a suspected diagnosis of secondary choledocholithiasis, the diagnostic efficacy of the combination of imaging results, biochemical indexes, common bile duct width, and other abnormal indicators for choledocholithiasis is much higher than that of the single abnormal biochemical indexes for the prediction of choledocholithiasis. For MRCP-negative patients, GGT, ALP, DB, and the width of common bile duct diameter are valuable for the prediction of common bile duct stones, and GGT is the most valuable diagnostic predictor.

The Value of Contrast-Enhanced Ultrasound-Guided Contrast Injection via the Endoscopic Nasobiliary Drainage Duct in Diagnosing Residual Common Bile Duct Stones.

Objectives To investigate the diagnostic value of contrast-enhanced ultrasound- (CEUS-) guided contrast injection via an endoscopic nasobiliary drainage (ENBD) tube on the evaluation for residual stones in common bile duct (CBD). Methods 116 patients with CBD stones were treated by endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy incision surgery and ENBD. The US group consisted of 54 patients who underwent US-guided saline injection via the ENBD tube to evaluate for residual CBD stones. The CEUS group consisted of 62 patients who underwent CEUS-guided contrast injection via the ENBD tube to evaluate for residual CBD stones. The length and width of CBD and the detection rate of residual stones before and after NS injection were compared. Results In both the US group and the CEUS group, the rate of complete demonstration and the average length and width of CBD before and after injection of NS were all increased significantly. In the US group, 6 patients had verified residual stones, 1 of which was detected by conventional US (detection rate, 1/6), 5 of which were detected by saline injection ultrasound (detection rate, 5/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on saline injection US and 2 false positives on ENBD cholangiography. In the CEUS group, 6 patients had verified residual stones, none of which were detected by conventional US (detection rate, 0/6), all of which were detected by saline injection CEUS (detection rate, 6/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on ENBD cholangiography. Conclusions CEUS-guided contrast injection via an ENBD tube helps to provide clear observation of residual stones in the CBD after ERCP with EST and provides comprehensive information for follow-up.

Bedside score predicting retained common bile duct stone in acute biliary pancreatitis.

BACKGROUNDRetained common bile duct (CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.AIMTo generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.METHODSWe performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients (21.5%) were diagnosed with CBD stone by endoscopic ultrasound (US).RESULTSIn univariate analysis, age (OR: 1.048, P = 0.0004), aspartate transaminase (OR: 1.002, P = 0.0015), alkaline phosphatase (OR: 1.005, P = 0.0005), gamma-glutamyl transferase (OR: 1.003, P = 0.0002) and CBD width by US (OR: 1.187, P = 0.0445) were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone; age (OR: 1.062, P = 0.0005), gamma-glutamyl transferase level (OR: 1.003, P = 0.0003) and dilated CBD (OR: 3.685, P = 0.027), with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity (90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity (82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.CONCLUSIONWe recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.

Predicting common bile duct stones by non-invasive parameters

Common bile duct (CBD) stone affect about 10% of patients with symptomatic cholelithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) published a strategy in 2010 for managing patients with suspected choledocholithiasis. This study aimed to assess the performance of different clinical parameters in predicting CBD stones. A total of 344 patients suspected to suffer from CBD stone and referred to endoscopic ultrasound (EUS) were included. Parameters were collected and their prediction power for CBD stones was assessed. One hundred and sixty-seven patients without CBD stone according to EUS (group A) were compared to 177 patients with CBD stones (group B). Several predictive factors for CBD stone were identified on univariate analysis. In multivariate regression analysis, CBD width by US (OR=1.224, 95% CI: 1.073-1.359; P=0.0026), age (OR=1.023, 95% CI: 1.011-1.035; P=0.0002) and gamma glutamyl transferase (GGT) level (OR=1.001, 95% CI: 1.000-1.002; P=0.0018) were significantly correlated with CBD stone, with receiver operator characteristics (ROC) of 0.7259. We generated a diagnostic equation [age (yr)×0.1+CBD width (mm) by US×1+GGT (U/L)×0.005] to predict CBD stone with ROC of 0.7287. We suggest this score as a very strong predictor for CBD stones, and to reduce the strength of total bilirubin and transaminases as predictors.

The value of contrast-enhanced ultrasound guiding normal saline injection in the detection of residual common bile duct stones

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) guiding normal saline (NS) injection through endoscopic nasobiliary drainage duct(ENBD) on evaluation for residual stones in common bile duct. Methods Fifty-five patients with bile duct stones were treated by endoscopic retrograde cholangio-pancreatography (ERCP) and duodenoscopic sphincterotomy incision surgery (EST) and ENBD. All patients received normal ultrasonography and CEUS guiding NS injection ultrasonography after EST. The length and width of common bile duct and the detection rate of residual stones before and after NS injection were compared. Results In the 55 patients, 1 patient failed in injection of contrast agent into the ENBD.In the other 54 patients, the difference of the length and width of common blie duct before and after NS injection were statistically significant [(2.94±1.76)cm vs (6.09±1.46)cm, (0.58±0.30)cm vs (1.11±0.98)cm](all P<0.001). The full display rate of the common bile duct before and after NS injection were 13.0%(7/54) and 90.7%(49/54), respectively. Before injection, none of common bile duct stones was suspected.After injection, 5 cases of common bile duct stones were suspected. Three cases were confirmed by ERCP, 1 case was confirmed by operation and 1 case was false positive. Conclusions CEUS of the common bile duct through ENBD performs its patency and course. On this basis the injection of NS increases the display rates of common bile duct, thus improving the detection rate of residual stones. Key words: Contrast-enhanced ultrasound; Choledocholithiasis; Endoscopic nasobiliary drainage duct

Magnetic resonance imaging features of choledochal traumatic neuroma

Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma, and investigate the key points of diagnosis and differentiation. Methods This was a retrospective descriptive study. The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August, 2015 were collected. The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP). Observational indexes included: (1) imaging features: location, size, signal intensity and enhancement characteristics of the lesion; (2) treatment and prognosis: surgical treatment, pathological findings, results of immunohistochemical staining and clinical follow-up. After preoperative related examinations, the patient and relatives were willing to receive surgical therapy, and postoperative pathological examinations and immunohistochemical staining were conducted. The follow-up using outpatient examination was performed to detect the patient′s recovery and clinical symptoms up to January 2016. Ultrasound and laboratory examinations [alanine transaminase (ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded. Results (1) Imaging features: pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct. The nodular was measured 1.2 cm×0.9 cm at maximum cross-section. The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma, slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image. MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts. The width of common bile duct was 1.4 cm. After administration of contrast materials, the nodular showed avid enhancement and delay enhancement, which was mild enhancement at the artery phase, and gradual increase at the portal vein phase and the delay phase. The length of central stricture of the common bile duct was 1.3 cm. There was no abnormal enhancement in liver, spleen and pancreas. No retroperitoneal lymphadenopathy could be seen. The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts. (2) Treatment and prognosis: the patient received surgery for tumor resection and Roux-en-Y reconstruction. The removed gross specimen was a grey-white nodular measured 2.0 cm×1.0 cm. The cute surface was grey-white and stiff. The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma. Normal biliary epithelial cells can be seen beside the nerve bundles. Immunohistochemical staining showed S-100 and Vimentin were positive. The index of Ki-67 was 5%. The patient was discharged at 14 days postoperatively with the good recovery. During postoperative 5-month follow-up, the patient had good recovery and jaundice scleras were disappeared. Ultrasound showed the bile ducts were not dilated. The results of laboratory examinations were normal. Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration. Key words: Traumatic neuroma; Biliary system; Magnetic resonance imaging

Hepaticojejunostomy leak after pancreaticoduodenectomy

Background: Hepaticojejunostomy (HJ) leak is the second common anastomotic failure after pancreaticoduodenectomy (PD), but only a few studies have focused on this complication. We evaluated the incidence of HJ leak after PD and described its presentation, treatment, and outcome. Methods: Records of 292 consecutive patients who underwent PD between 2007 and 2014 were retrospectively analysed. Clinicopathologic data were compared with patients without HJ leaks, and presentation, radiologic findings, treatment, and outcome of HJ leaks were analysed. Results: HJ leak was identified in 14 (4.8%) patients. Low serum albumin on postoperative day 1 (POD1) was associated with an increased risk, while dilation of common hepatic duct and preoperative biliary decompression were two protected factors. Median postoperative day of diagnosis was 5 (range, 1-15). Typical clinical signs included bilious drainage in the surgically placed drains, with fever, abdominal pain and leukocytosis. Patients with HJ leaks had more pancreatic fistulas and other complications included Intra-abdominal abscess, wound infection and delayed gastric emptying. 4 (29%) patients were treated operatively, 5 required percutaneous drainage and 5 underwent conservative management. One patient died in hospital, resulting in a mortality of 7%. Conclusion: Hepaticojejunostomy leaks are rare after PD. The complication severity ranges from trivial to life threatening. It may be associated with nutritional status, width of common bile duct and surgical procedures. Surgical interventions are required for more than half of HJ leaks. A good outcome can be expected.

Ultrasonographic dimensions of the common bile duct in Chinese children: Results of 343 cases

BackgroundAt present, the diagnostic criteria of congenital cholangiectasis are still vague. PurposeThe aim of this study was to assess the diameter references of the common bile duct (CBD) in pediatric population in different age groups with ultrasound. MethodsThe diameter of the common bile duct was measured with ultrasound in 343 Chinese Han children aged 1day to 14years (mean: 3.2years, median: 2.8years) who were all free of hepatic and biliary tract disease. The ultrasound records, gender, and age were collected for reviewed analysis. ResultsA total of 343 children were included, and the CBD was clearly detected in 322 cases (93.9%). The mean diameter of this population was 1.58±0.70mm. (ranging from 0.4 to 4.4mm). Spearman correlation analysis showed that the diameter of CBD was positively associated with age (r=0.573, P<0.001). The percentile method demonstrated that the diameter references of CBD was as follows: ≤1years: ≤2.26mm; ≤4years: ≤2.99mm; ≤7years: ≤3.03mm; and ≤14years: ≤4.10mm. ConclusionsThere was a close correlation between CBD width and the age. The range of CBD widths in each age group will be helpful in the diagnosis of biliary dilatation in childhood.

Behavior of the Common Bile Duct Diameter Before and 12 Years after Choledochostomy for Cholecystolithiasis and Choledocholithiasis. A Prospective Study

IntroductionIn patients with common bile duct (CBD) stones, the diameter of the CBD is usually dilated. After surgery, the behavior of CBD diameter is not clearly known. ObjectiveTo determine at a late follow-up the width of CBD before and after choledochostomy for CBD stones. Material and MethodsIn this prospective study, 39 patients with gallstones and CBD stones were included. They were 30 women and 9 men with a mean age of 52.6 years. In all ultrasound, determination of the CBD caliber before and 12 years after surgery was performed. ResultsThe mean value of the inner diameter of the CBD before surgery was 11.6 and 12.3mm in patients below or above 60 years, respectively. Measurement 12 years after surgery showed a mean decrease of nearly 50% of preoperative values, which was highly significant (p < 0.0001). However, either below or above 60 years, only 75% of the patients showed this decrease, whereas 25% remained unchanged. ConclusionThe dilated preoperative CBD returns to normal or near normal values in 3/4 of the patients after surgical exploration of the CBD and extraction of the stones.

Difference of CBD width on US vs. ERCP

To investigate the relationship between US and ERCP in the measurement of common bile duct (CBD) width after application of Compound and Harmonic imaging on ultrasound. We prospectively evaluated the CBD width as measured on endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (US), applying Compound and Harmonic US techniques, on 100 patients. Furthermore, we retrospectively re-examined US and ERCP images of 48 patients who underwent ERCP and US during the same hospitalization period. The average difference in measurements by US compared to ERCP was 2.3 mm (P < 0.01) in the retrospective and 1.9 mm in the prospective study (P < 0.001). The average difference in measurements between US and ERCP in post-cholecystectomy patients was 4.0 mm in the retrospective study (10 patients), and 3.8 in the prospective study (25 patients). The difference between the measurements on both examinations decreased with increasing CBD width. There was a good correlation between ERCP and US measurements of CBD width (r = 0.73 for all patients and r = 0.88 for patients with intact gallbladder, P < 0.001). There is a gap between measurement of CBD width on US and ERCP of about 2 mm. The application of Compound and Harmonic techniques in the prospective study probably enabled a more accurate sonographic measurement.

A CASE OF EARLY GALLBLADDER CANCER ASSOCIATED WITH ANOMALOUS ARRANGEMENT OF PANCREATICOBILIARY DUCT

A 53-year-old female was admitted to the hospital because of abdominal pain, and was found having a 2.0cm sized gallstone by abdominal CT and US. ERCP film showed 14mm width of common bile duct and 16 mm length of common cahannel, so anomalous arrangement of pancreaticobiliary duct with a low grade cystic dilatation of the common bile duct was suspected. After cholecystecotmy, anomalous arrangement was confirmed by manometric study of the common channel. Then resection of the extrahepatic common bile duct and hepatico-jejunostomy were performed. Values of amylase of bile juce both in the gallbladder and common bile duct were with in normal range. While no malignant cells were found in the intraoperative frozen section diagnosis of the gallbladder, but well differentiated adenocarcinoma (m, ly0, v0) was found in the paraffin section postoperatively. In a review of the Japanese literature, only 21cases of early gallbladder cancer associated with anomalous arrangement of pancreaticobiliary duct could be found.