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World J Gastrointest Endosc. Jul 10, 2015; 7(8): 799-805
Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.799
Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes
Claudio De Angelis, Milena Marietti, Mauro Bruno, Rinaldo Pellicano, Mario Rizzetto
Claudio De Angelis, Milena Marietti, Mauro Bruno, Rinaldo Pellicano, Mario Rizzetto, Department of Gastroenterology and Digestive Endoscopy, “Città della Salute e della Scienza”, University of Turin, 10126 Turin, Italy
Author contributions: De Angelis C and Rizzetto M designed the aim of the editorial and critically revised the manuscript for important intellectual content; Marietti M and Bruno M equally contributed to acquisition, analysis and interpretation of data and wrote the manuscript; Pellicano R wrote and revised the manuscript.
Conflict-of-interest statement: The authors have nothing to disclose regarding funding from industries or conflict of interest with respect to this manuscript.
Open-Access: 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/
Correspondence to: Claudio De Angelis, MD, Professor, Department of Gastroenterology and Digestive Endoscopy, “Città della Salute e della Scienza”, University of Turin, corso Bramante 88, 10126 Turin, Italy. eusdeang@hotmail.com
Telephone: +39-011-6335558 Fax: +39-011-6335927
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: October 14, 2014
Revised: April 13, 2015
Accepted: May 26, 2015
Article in press: May 28, 2015
Published online: July 10, 2015
Abstract

In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among non-jaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects.

Keywords: Unexplained common bile duct dilatation, Endoscopic ultrasound, Normal liver enzymes

Core tip: Common bile duct dilatation, often without identified causes, in subjects with normal liver function tests and nonspecific abdominal symptoms, and absence of lesions on prior noninvasive imaging tests, is increasingly found in the clinical practice. Since the clinical suspicion for biliary pathology in that setting is usually low, and there are limited literature data, this condition is ignored. However, recent evidences show the existence of pathologies among these patients, often with a non-benign course. In this scenario, endoscopic ultrasound may have a role in the identification of the etiology of dilatation.