title: For biliary dilatation, a negative endosonography needs additional image studies in weight loss suggesting malignancy.
abstract: OBJECTIVE
  Biliary dilatation frequently raises concerns about the possibility of pancreatobiliary diseases. This study assessed the etiologic yield of endosonography (EUS) in this situation.
  
  
  METHODS
  A retrospective review was completed with 163 consecutive patients who had undergone EUS for a dilated common bile duct (CBD) without definite pathology on ultrasonography.
  
  
  RESULTS
  Binary logistic regression analysis disclosed that malignancy was positively related to weight loss and was inversely related to abdominal pain; nevertheless, choledocholithiasis was positively related to fever and elevated carbohydrate antigen 19-9 (p < 0.05). The accuracy of EUS was 95.1 % (155/163) for overall cause of biliary dilatation, 100 % (73/73) for no pathological finding, 96.3 % (26/27) for ampullary cancer, 84.6 % (11/13) for pancreatic cancer, 40.0 % (2/5) for CBD cancer, and 92.6 % (25/27) for choledocholithiasis, respectively. The accuracy of EUS decreased in the presence of malignancy (86.7 %, 39/45 vs. 98.3 %, 116/118, p = 0.006). EUS missed three CBD cancers, two pancreatic cancers, and one ampullary cancer; however, the diagnosis was rescued by computed tomography in two pancreatic cancers and one CBD cancer.
  
  
  CONCLUSIONS
  EUS is accurate in patients with fever suggestive of choledocholithiasis. However, a negative EUS finding should call for additional image studies in patients with weight loss suggestive of malignancy.
authors.affiliation: Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, No. 542, Section 1, Chung-Shang Road, Changhua, 500, Taiwan. showchench@yahoo.com.tw
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Chen
authors.forename: Chi-Chieh
authors.initials: CC
authors.lastname: Yang
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000465:Algorithms; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000473:pathology*; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
references.citation: Radiology. 1997 Nov;205(2):523-30
references.pmid: 9356639
references.citation: Gastrointest Endosc. 2009 Jul;70(1):29-36
references.pmid: 19286177
references.citation: J Clin Gastroenterol. 2001 Oct;33(4):302-5
references.pmid: 11588544
references.citation: AJR Am J Roentgenol. 1997 Jul;169(1):119-23
references.pmid: 9207510
references.citation: Fukushima J Med Sci. 2010 Dec;56(2):99-106
references.pmid: 21502709
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1632-9
references.pmid: 17521400
references.citation: Scand J Gastroenterol. 2009;44(1):93-9
references.pmid: 18821171
references.citation: Radiology. 2004 Oct;233(1):234-40
references.pmid: 15333766
references.citation: J Clin Oncol. 2006 Nov 20;24(33):5313-27
references.pmid: 17060676
references.citation: Oncology. 2004;66(3):167-79
references.pmid: 15218306
references.citation: J Comput Assist Tomogr. 2005 Jul-Aug;29(4):438-45
references.pmid: 16012297
references.citation: Dig Dis Sci. 2012 Dec;57(12):3246-51
references.pmid: 22729595
references.citation: HPB (Oxford). 2006;8(6):409-25
references.pmid: 18333096
references.citation: Radiology. 1994 Mar;190(3):745-51
references.pmid: 8115622
references.citation: Gastrointest Endosc. 2002 Jun;55(7):870-6
references.pmid: 12024143
references.citation: J Gastroenterol Hepatol. 2004 Apr;19(4):454-9
references.pmid: 15012785
references.citation: Br J Surg. 1999 Feb;86(2):189-93
references.pmid: 10100785
references.citation: Radiol Med. 2010 Aug;115(5):732-46
references.pmid: 20177983
references.citation: Gastrointest Endosc. 1998 Jul;48(1):1-10
references.pmid: 9684657
references.citation: Radiology. 1999 Aug;212(2):445-52
references.pmid: 10429702
references.citation: Lancet. 2000 Nov 4;356(9241):1607-8
references.pmid: 11075797
references.citation: AJR Am J Roentgenol. 1998 Apr;170(4):1055-9
references.pmid: 9530058
references.citation: J Hepatobiliary Pancreat Surg. 2008;15(1):7-14
references.pmid: 18274839
references.citation: Gastrointest Endosc. 1992 Jan-Feb;38(1):27-34
references.pmid: 1612375
references.citation: Gastrointest Endosc. 1997 Feb;45(2):143-6
references.pmid: 9040999
references.citation: Endoscopy. 2000 Jan;32(1):3-9
references.pmid: 10691265