Abdullah Shaikh MD, Presenter: Nothing to Disclose

Sandra Bellantonio MD, Abstract Co-Author: Nothing to Disclose

David Desilets MD, PhD, Abstract Co-Author: Nothing to Disclose

The aim of this study was to determine whether dilatation of the Common Bile Duct (CBD) on ultrasound is associated with CBD calculi on Endoscopic Retrograde Cholangio-pancreatography (ERCP) in patients over the age 65.

An experienced endoscopist prospectively collected data on 2,018 patients undergoing ERCP in a tertiary referral center from 7/00 to 7/07. Two hundred eighty-two patients with an Ultrasound (US) report of “Dilated Common Bile Duct” with no report of calculi were referred for ERCP. Of these, 114 patients (40%) had ducts ≤ 10mm, and 168 (60%) had ducts > 10mm. We divided the two groups based on age < or ≥ age 65; the ≤ 10mm group had 19 patients (17%) aged ≥ 65, and the >10mm group had 94 (56%) geriatric patients. The older patients were retrospectively selected for analysis (chi square) and compared with non-geriatric patients with similar findings. All analyzed patients were symptomatic, had an ultrasound, and a biliary sphincterotomy and balloon or basket sweep of the CBD.

The overall incidence of calculi on ERCP was similar in older and younger patients and 47% and 42%, respectively. However, 46/94 (49%) of patients ≥ age 65 with a CBD diameter >10mm on US had an ERCP confirmed CBD stone, compared to only 23/74 (31 %) of younger patients (p=. 019). We found no statistically significant difference in the incidence of calculi between the older and younger age group when the CBD measured ≤ 10 mm on US (p=.27). Thus giving US a Negative Predictive Value of 68.9% when the report states no stones and the duct is >10mm.

Less than half of all patients referred to ERCP for a dilated CBD with no mention of stones on US have ERCP confirmed calculi, regardless of age. CBD dilatation of > 10mm on US is more associated with calculi in older but not in younger patients. Other authors have reported that a dilated CBD is associated with increasing age, and in 98% of the patients studied duct dilatation was 6-7 mm (upper limit of normal=7-8mm). Thus, a dilated CBD on US in older patients should trigger an evaluation for calculi or other conditions, and should not be considered an incidental finding or part of normal aging especially in symptomatic patients.

Other pathologies must equally be considered when CBD dilatation with no calculi is reported on US in both young and older patients.

Shaikh, A, Bellantonio, S, Desilets, D, The Significance of Common Bile Duct Dilatation in Older Adults.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6009246.html