1. Clinical predictors of significant findings on EUS for the evaluation of incidental common bile duct dilation.
- Author
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Raza Z, Altayar O, Mahmoud T, Abusaleh R, Ghazi R, Early D, Kushnir VM, Lang G, Sloan I, Hollander T, Rajan E, Storm AC, Abu Dayyeh BK, Chandrasekhara V, and Das KK
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Dilatation, Pathologic diagnostic imaging, Abdominal Pain etiology, Adenoma diagnostic imaging, Adenoma pathology, Age Factors, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms pathology, Aged, 80 and over, Logistic Models, Cholecystectomy, Common Bile Duct Neoplasms diagnostic imaging, Common Bile Duct Neoplasms pathology, Common Bile Duct Diseases diagnostic imaging, Retrospective Studies, Ampulla of Vater diagnostic imaging, Multivariate Analysis, Endosonography methods, Choledocholithiasis diagnostic imaging, Incidental Findings, Common Bile Duct diagnostic imaging, Common Bile Duct pathology
- Abstract
Background and Aims: Although EUS is highly accurate for the evaluation of common bile duct (CBD) dilation, the yield of EUS in patients with incidental CBD dilation is unclear., Methods: Serial patients undergoing EUS for incidental, dilated CBD (per radiologist, minimum of >6 mm objectively) from 2 academic medical centers without active pancreaticobiliary disease or significantly elevated liver function test results were evaluated. Multivariable logistic regression identified predictors of EUS with significant findings and a novel prediction model was derived from one center, internally validated with bootstrapping, and externally validated at the second center., Results: Of 375 patients evaluated, 31 (8.3%) had significant findings, including 26 choledocholithiasis, 1 ampullary adenoma, and 1 pancreatic mass. Predictors of significant findings with EUS included age of ≥70 years (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-10.0), non-biliary-type abdominal pain without chronic pain (OR, 6.1; 95% CI, 2.3-17.3), CBD diameter of ≥15 mm or ≥17 mm with cholecystectomy (OR, 6.9; 95% CI, 2.7-18.7), and prior ERCP (OR, 6.8; 95% CI, 2.1-22.5). A point-based novel clinical prediction model was created: age of ≥70 years = 1, non-biliary-type abdominal pain without chronic pain = 2, prior ERCP = 2, and CBD dilation = 2. A score of <1 had 93% (development) and 100% (validation) sensitivity and predicted a <2% chance of having a significant finding in both cohorts while excluding the need for EUS in ∼30% of both cohorts. Conversely, a score of ≥4 was >90% specific for the presence of significant pathology., Conclusions: Less than 10% of patients undergoing EUS for incidental CBD dilation had pathologic findings. This novel, externally validated, clinical prediction model may reduce low-yield, invasive evaluation in nearly one-third of patients., Competing Interests: Disclosure The following authors disclosed financial relationships: V. Chandrasekhara: Consultant for Boston Scientific and Covidien LP, research funding from STARmed and Micro-tech, and equity interest in Nevakar Corporation. A. C. Storm: Research grant from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGSS, Enterasense, MGI Medical, OnePass, and SofTac; consultant for Ambu, Boston Scientific, Envision Endoscopy, Intuitive, Medtronic, Microtech, and Olympus. E. Rajan: Coinvestigator for Medtroic and Ruhoff and consultant for Olympus and Johnson & Johnson. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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