PTH-067 Yield of Endoscopic Ultrasound (EUS) in Patients with Dilated Common Bile Duct (CBD) and or Pancreatic Duct (PD) with normal Liver Function Test (LFTS) and Cross-Sectional Imaging

Abstract

Introduction: There is limited literature on the yield of EUS in patients with dilated ducts, normal LFTs and non- diagnostic imaging (CT and or MRI). Method(s): All patients undergoing EUS for normal LFTs and unexplained CBD and or PD dilatation between January 2007 and August 2011 were identified. Follow up was for a minimum of 12 months. Result(s): 83 patients (3% of EUS procedures during this period) were identified. Mean age was 66.7 (30 - 87). There was a female preponderance (73%). 40(48%) had dilated CBD only, 5(6%) had solitary PD dilatation and 38(46%) had both CBD and PD dilatation on prior imaging. EUS was concordant with prior imaging in 60(72%) patients and discordant in 23(28%) [partial agreement in 18, non-dilated ducts in 3 and different duct dilated in 2]. 16(19%) patients had a new finding on EUS [3 cbd stones, 3 cbd polyps, 4 microlithiasis, 1 ampullary adenoma, 3 chronic pancreatitis, 1 pancreatic duct adenocarcinoma (PDAC) and 1 portal vein compressing mid CBD]. Of these 11(13%) were felt to be the cause of duct dilatation. On subsequent MDT review, the PDAC was identified on the initial scan. 7(17.5%) of the isolated CBD dilatation, 3(60%) of the isolated PD dilatation and 1(2.5%) of the dilated CBD and PD had a causative diagnosis respectively. Conclusion(s): EUS is a worthwhile test in individuals with unexplained duct dilatation and normal LFT. The yield was highest in isolated PD dilatation. EUS should ideally follow review of original cross sectional imaging by a HPB radiologist.