Barakat MT, Banerjee S. Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department. World J Hepatol 2020; 12(12): 1289-1298 [PMID: 33442455 DOI: 10.4254/wjh.v12.i12.1289]
Corresponding Author of This Article
Subhas Banerjee, MD, Professor, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, United States. subhas.banerjee@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2020; 12(12): 1289-1298 Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1289
Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department
Monique T Barakat, Subhas Banerjee
Monique T Barakat, Divisions of Adult and Pediatric Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94305, United States
Subhas Banerjee, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94304, United States
Author contributions: Barakat MT and Banerjee S were involved in conception and design of the study as well as collection, analysis and interpretation of the data in collaboration with the Stanford University Statistics Consulting Service; Barakat MT and Banerjee S were involved in drafting and critical revision of the article for important intellectual content; Banerjee S granted final approval of the article.
Institutional review board statement: This study was approved by the Stanford University Institutional Review Board (Protocol No. 41605), with associated HIPPA and Consent Waivers.
Informed consent statement: Informed consent signature not required from patients for this retrospective cohort study, per terms of Institutional Review Board (IRB) protocol approval.
Conflict-of-interest statement: The authors have no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Subhas Banerjee, MD, Professor, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, United States. subhas.banerjee@stanford.edu
Received: August 2, 2020 Peer-review started: August 2, 2020 First decision: September 30, 2020 Revised: October 12, 2020 Accepted: October 30, 2020 Article in press: October 30, 2020 Published online: December 27, 2020
ARTICLE HIGHLIGHTS
Research background
Bile duct dilation is often related to an obstructive process such as a stone, stricture or a mass. The role of other patient factors such as height, weight, body mass index, and substance use in modulating biliary dilation have not been well defined.
Research motivation
In the past two decades, both opiate use/dependence and utilization of cross-sectional abdominal imaging have sharply increased. We have noted an increase in referrals to our academic tertiary care medical center for incidentally detected biliary dilation, particularly in patients who use opiates.
Research objectives
Our goal was to evaluation associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index to understand how these factors may be related to biliary dilation.
Research methods
We evaluated associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index utilizing our institution’s integrated informatics platform. We evaluated 1685 Emergency Department patients (a 20% sample from 2011-2016) who had undergone cross-sectional abdominal imaging and had normal total bilirubin.
Research results
Diameter of the common bile duct was significantly higher in opiate users compared to non-opiate users (8.67 mm vs 7.24 mm, P < 0.001) and in patients with a history of cholecystectomy compared to those with an intact gallbladder (8.98 vs 6.72, P < 0.001). For patients with an intact gallbladder who did not use opiates (n = 432), increasing age did not predict common bile duct (CBD) diameter (r2 = 0.159, P = 0.873).
Research conclusions
A history of cholecystectomy and opiate use are associated with common bile duct dilation in the absence of an obstructive process. Age alone does not appear to be associated with increased common bile duct diameter.
Research perspectives
These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter. Future prospective study would be desirable to expand upon these findings.
