The Value Of Linear Endoscopic Ultrasonography In Diagnosing The Etiology Of Distal Common Bile Duct Dilatation

Background and Purpose:Distal common bile duct dilatation is not rare,but the etiology is a contentious issue due to its complex anatomical structure and diverse diseases.Linear endoscopic ultrasonography can not only visualize the distal and surrounding structures of the bile duct closely,but also perform fine needle aspiration(FNA)to obtain pathological specimens,which provides an important basis for the diagnosis and differential diagnosis of the disease.The purpose of this study was to explore the diagnostic value of Linear EUS in the etiology of distal common bile duct dalitation.Materials and methods:Patients with distal common bile duct dilatation underwent linear EUS in the endoscopic center of The Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan were collected from January 2015 to June 2019,and the results of surgery,endoscopic pathology and follow-up were retrospectively analyzed.Results:A total of 160 patients were enrolled in this study,including 77 males and 83 females,with an average age of 64±12 years.The causes of the common bile duct dilatation were finally diagnosed as 53 cases with choledocholithiasis,43 cases with malignant tumors of duodenal papilla,14 cases with malignant tumors in the distal common bile duct,19 cases with space-occupying lesions on head of pancreas(including IPMN),8 cases with cholangitis,9 cases with compensatory dilatation after cholecystectomy,4 cases with congenital choledochal cyst and 1 case with adenomyosis of the common common bile duct.According to the causes of other benign lesions,there were 3 cases with the descending part of duodenum diverticulum,3 cases with the mass autoimmune pancreatitis,2 cases with the pancreatic pseudocyst and 1 case with external pressure of heterotopic pancreas.For the diagnosis of choledocholithiasis,the diagnostic accuracy of Linear EUS was 97.5%,which was significantly higher than that of MRI(86.36%)and CT(89.74%),with statistically significant differences(P<0.001 and 0.006,respectively).The diagnostic accuracy of Linear EUS for periampullary tumors was 93.75%,which was higher than MRI and CT with an accuracy of 82.73%and 80.34%,with statistically significant differences(P values were 0.004 and 0.001,respectively).Conclusion:Linear EUS has important diagnostic value for the etiology of distal common bile duct dilatation.