title: Bile duct dilation with chronic methadone use in asymptomatic patients: ERCP findings in 6 patients.
abstract: BACKGROUND
  Bile duct dilation in patients being treated by chronic narcotic substitution with methadone has been described but has not been systematically evaluated with ERCP. Retrograde cholangiographic findings in 6 patients taking methadone who were referred for evaluation of a dilated bile duct are described.
  
  
  METHODS
  Six patients with chronic hepatitis (5 because of hepatitis C virus, 1 hepatitis B virus) who were taking methadone were evaluated by ERCP because of biliary dilation. Data were obtained regarding surgery, abdominal pain, weight loss, excessive ingestion of alcohol, liver disease, pancreatitis, and the dose and duration of methadone treatment.
  
  
  METHODS
  ERCP revealed bile duct dilation without evidence of choledocholithiasis, stricture, or obstructing mass. There was one complication (postprocedure pain thought to be due to methadone withdrawal).
  
  
  CONCLUSIONS
  Chronic methadone use can lead to bile duct dilation without evidence of other significant pathology in asymptomatic patients. EUS may be safer than ERCP for evaluation of these patients, given that a need for therapeutic biliary intervention is unlikely.
authors.affiliation: NYU School of Medicine, Bellevue Hospital Center, New York, USA.
authors.forename: Babak
authors.initials: B
authors.lastname: Firoozi
authors.forename: Rosa
authors.initials: R
authors.lastname: Choung
authors.forename: David L
authors.initials: DL
authors.lastname: Diehl
mesh_terms: D001649:Bile Duct Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004108:Dilatation, Pathologic / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008691:Methadone / Q000009:adverse effects* / Q000627:therapeutic use; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000188:drug therapy
chemical_list: D008691:Methadone