Isolated and unexplained dilation of the common bile duct on computed tomography scanscans (original) (raw)
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Endoscopy, 2011
Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4±20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n=165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n=6), Gall stones (n=12), Biliary ascarrisis (n=22), Choledocholithiasis (n=42), Acute Pancreatitis (n=9), Chronic Pancreatitis (n=15), Pancreatic pseudocysts(n=4) (B) Malignant Pathologies : GB Carcinoma(n=4), Cholangiocarcinoma (n=29), Capancreas (n=9), Periampullary carcinoma (n=12).Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n=9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n=2) for restaging or recurrence after chemoradiation and 21% (n=4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, 07 were for staging of gastric carcinoma, 04 were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and 02 for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.
Egyptian Liver Journal, 2022
Background/aims: We prospectively evaluated the role of endoscopic ultrasound (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom trans-abdominal ultrasound (TUS) could not demonstrate the cause of dilation as a proper second step in the diagnostic workup of patients with obstructive jaundice compared to magnetic resonance cholangiopancreatography (MRCP). Methods: This study was conducted on patients with obstructive jaundice admitted to the inpatient ward or the outpatient endoscopy unit of Theodor Bilharz Research Institute (TBRI) during the period between January 2019 and August 2019. A patient with obstructive jaundice and TUS showed CBD dilatation with internal diameter ≥ 7 mm and biliary stricture. Results: During the period between January 2019 and August 2019, 136 were recruited; 8 patients who were pregnant and 3 patients who had gastric bypass surgery were excluded. Sixty-five patients were diagnosed confidently by TUS as biliary stones and were excluded from the analysis. Sixty patients with obstructive jaundice and indefinite etiology on TUS were included in the final analysis. The final diagnosis of patients was 38 patients (63.33%) of malignant etiology [26 pancreatic cancer (43.33%), 4 cholangiocarcinoma (6.66%), and 8 with ampullary cancer (13.33%)] and 22 patients (36.67%) of benign etiology [10 calcular obstruction (16.66%), 8 benign stricture (13.33%), and 4 pancreatitis (6.66%)]. The sensitivity and specificity values for malignant stricture detected by EUS were 100% and 86.36%, respectively, with positive predictive value of 92.68%, negative predictive value of 100%, and accuracy of 95%, while MRI showed 82.14% sensitivity and 25% specificity with positive predictive value of 79.31 and accuracy of 69.4%. EUS supported correct diagnosis in 57 patients (95%: CI 86.08 to 98.96%) while MRI did it in 36 patients (69.44%: CI 51.89% to 83.65%).Only 43 (71.7%) patients needed endoscopic retrograde cholangiopancreatography (ERCP) for management of obstructive jaundice, sparing 17 patients (28.3%) unnecessary invasive procedures. Conclusions: EUS is a minimally invasive method with low incidence of complications with high diagnostic accuracy in patients with dilated CBD and normal MRCP.
Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases
Cytopathology, 2006
Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases Objective: Endoscopic retrograde cholangiopancreaticography (ERCP)-guided brushing has been the standard of practice for surveillance and detection of carcinoma in the biliary tree. Few studies have evaluated the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in diagnosing clinically suspected cholangiocarcinoma. The role of this method in diagnosing clinically suspected gallbladder malignancies has not been extensively evaluated in the USA. This study investigates the role of EUS-FNA in the diagnosis of clinically suspected biliary tree and gallbladder malignancies in a large patient series. Methods: EUS-FNAs were obtained from 46 bile duct and seven gallbladder lesions. On-site rapid interpretation was provided using air-dried Diff Quik stained smears. In addition, alcohol fixed Papanicoloau stained smears and Thin Prep preparations (Cytye Corp., Marlborough, MA, USA) were evaluated before providing a final cytological diagnosis. Tissue biopsies and/or clinical follow-up were used as the standards to determine operating characteristics for EUS-FNA. Results: The mean ages for bile duct and gallbladder lesions were 66 years (range: 37-84 years), and 69 years (range 49-86 years), respectively. All cases diagnosed as suspicious/malignant on preliminary evaluation were confirmed on final cytological interpretation (27/27). The operating characteristics show that EUS-FNA is highly specific (100%) with sensitivity rates of 87% and 80% from clinically suspected malignancies of biliary tract and gallbladder, respectively. Sampling error in three cases and associated acute inflammation in two cases resulted in false-negative diagnoses. Conclusions: EUS-FNA of biliary tree and gallbladder carcinoma is highly specific and should be considered for evaluation of clinically suspicious lesions. Marked inflammation may result in false-negative diagnoses.
Diagnostic Cytopathology, 2014
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing, and post-biopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings, and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.
Background and study aims:Distal Common Bile Duct(CBD) lesions are sometimes difficult to diagnose due to the atypical nature or very small size of the lesion that is not identified on imaging modalities like Computerized tomography(CT) and Magnetic ResonanceCholangiopancreaticography(MRC P). The aim of this article is to show the pivotal role of Endoscopic Ultrasonography (EUS) in confirming the diagnosis which helps in choosing the best option of treatment. Patients and methods: In this case study 5 patients with distal CBD lesions but unconfirmed diagnosis on CT and MRCP were selected. The patients were made to undergo Endoscopic Ultrasound as an alternative imaging technique to identify the lesion. Result's and MRCP suggested possible space occupying lesions (SOL) in two cases but EUS confirmed the lesions as tumors. In two other cases the presence of calculus in distal CBD was not evident on CT, and MRCP could only suggest a possible calculus but EUS accurately diagnosed the lesion with the location and size of the stone. The other case was shown as a high-density shadow on CT and a possible stone on MRCP but EUS correctly diagnosed the lesion as tumor. Conclusion: EUS plays an important role in identification of distal CBD lesions accurately when CT and MRCP cannot give a definitive diagnosis.
2015
Jaundiceis theprecipitation of bilirubin in the tissues of the skin, sclera and mucous membranes causing a yellowish staining.It is pre-hepatic, hepatic or post hepatic. The post hepatic form is usually caused by obstruction of the common bile duct (CBD). Carcinoma of the head of pancreas (CPH)is a major cause of CBDobstructionsince it passes posterior to the head of the pancreas. The objective of this study is toassessthe effectiveness of the gray scale ultrasound to differentiate and diagnose the causes of obstructive jaundicewith an emphasis on the obstructive jaundice caused by CPH. Furthermore the influences of age, gender and occupation on CPH obstructive jaundice were also evaluated. This study was carried at Ebn-Siena Specialized Hospital - Khartoum state - Sudan, from January 2013 till June 2014. One hundred patients who were initially diagnosed to have obstructive jaundice were included in this study. Patients were selected thorough a good history and clinical examination,...
Cancer Cytopathology, 2014
BACKGROUND: The objective of this study was to assess how atypical diagnostic category (ADC) is followed up, its outcomes, and the predictors that are associated with subsequent diagnosis of neoplasm/malignancy. METHODS: We reviewed pancreatic endoscopic ultrasound fine-needle aspiration (EUS-FNA) with ADC and compared the rate of detection of neoplasms after a repeat FNA, a biopsy/resection, or a clinical follow-up following ADC. Logistic regression was used to determine the factors associated with the diagnosis of a neoplastic or a malignant lesion following ADC. Predictive probability for each case was calculated on the basis of the significant predictors, and whether it improved diagnostic performance was assessed. RESULTS: Of 3832 cases that received pancreatic EUS-FNAs, 187 (4.9%) were ADC. A total of 93 neoplasms (55%), including 61 carcinomas (36%), were detected after an atypical cytologic diagnosis. Similar rates of detecting neoplasms were observed after repeat FNA or biopsy/resection but higher than after clinical follow-up. The presence of a mass, history of alcohol use, and absence of a history of pancreatitis were significant predictors of a higher rate of diagnosis of neoplasm. Weight loss and bile flow obstruction were more likely to be associated with higher rates of carcinoma. Predictive probability demonstrated a wide range of risk and changed the ambiguous diagnosis to informative in 30% of cases. CONCLUSIONS: ADC of pancreas is associated with a high risk of benign and malignant neoplasms regardless of the method of follow-up. The presences of a mass, alcohol use, and absence of a history of pancreatitis are significant predictors of a diagnosis of neoplasm, whereas weight loss and bile duct obstruction are significant predictors of ductal carcinoma following an ADC.