Skip to main content
SpringerLink
Log in

What Should Be Done with a Dilated Bile Duct?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigations in patients with incidentally identified modest ductal dilatation without symptoms or laboratory abnormalities. Additional investigations are more likely to identify clinically relevant findings in patients with more pronounced dilatation. EUS is highly accurate, low-invasive, and useful in this setting, whereas ERC should be reserved for cases likely to require therapeutic intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mahour GH, Wakim KG, Ferris DO: The common bile duct in man: its diameter and circumference. Ann Surg 1966, 165:415–419.

    Article  Google Scholar 

  2. Adler DG, Baron TH, Davila RE, et al.: ASGE guideline: the role of ERCP in diseases of the biliary tract and pancreas. Gastrointest Endosc 2005, 62:1–8.

    Article  PubMed  Google Scholar 

  3. Niederau C, Sonnenberg A, Mueller J: Comparison of the extrahepatic bile duct size measured by ultrasound and by different radiographic methods. Gastroenterology 1984, 87:615–621.

    CAS  PubMed  Google Scholar 

  4. Stockberger SM, Wass JL, Sherman S, et al.: Intravenous cholangiography with helical CT: Comparison with endoscopic retrograde cholangiography. Radiology 1994, 192:675–680.

    CAS  PubMed  Google Scholar 

  5. Chung SC, Leung JW, Li AK: Bile duct size after cholecystectomy: an endoscopic retrograde cholangiopancreatographic study. Br J Surg 1990, 77:534–535.

    Article  CAS  PubMed  Google Scholar 

  6. Neoptolemos JP, Carr-Locke DL, Kelly KA: Factors affecting the diameters of the common bile duct and pancreatic duct using endoscopic retrograde cholangiopancreatography. Hepatogastroenterology 1991, 38:243–247.

    CAS  PubMed  Google Scholar 

  7. Dey J: Modeling and Analysis of Ultrasound Propagation in Layered Medium [doctoral dissertation]. Carnegie Mellon University; 1999. Available at http://www.ri.cmu.edu/publication_view.html?pub_id=3010. Accessed January 2010.

  8. Cooperberg PL: High-resolution real-time ultrasound in the evaluation of the normal and obstructed biliary tract. Radiology 1978, 129:477–480.

    CAS  PubMed  Google Scholar 

  9. Parulekar SG: Ultrasound evaluation of common bile duct size. Radiology 1979, 133:703–707.

    CAS  PubMed  Google Scholar 

  10. Bruneton JN, Roux P, Fenart D, et al.: Ultrasound evaluation of common bile duct size in normal adult patients and following cholecystectomy, a report of 750 cases. Eur J Radiol 1981, 1:171–172.

    CAS  PubMed  Google Scholar 

  11. Niederau C, Muller J, Sonnenberg A: Extrahepatic bile ducts in healthy subjects, in patients with cholelithiasis, and in postcholecystectomy patients: a prospective ultrasonic study. J Clin Ultrasound 1983, 11:23–27.

    Article  CAS  PubMed  Google Scholar 

  12. Kaim A, Steinke K, Frank M, et al.: Diameter of the common bile duct in the elderly patient: measurement by ultrasound. Eur Radiol 1998, 8:1413–1415.

    Article  CAS  PubMed  Google Scholar 

  13. Perret RS, Sloop GD, Borne JA: Common bile duct measurements in an elderly population. J Ultrasound Med 2000, 19:727–730.

    CAS  PubMed  Google Scholar 

  14. Bachar GN, Cohen M, Belenky A, et al.: Effect of aging on the adult extrahepatic bile duct. J Ultrasound Med 2003, 22:879–882.

    PubMed  Google Scholar 

  15. ASGE Standards of Practice Committee, Gan SI, Rajan E, et al.: Role of EUS. Gastrointest Endosc 2007, 66:425–434.

    Google Scholar 

  16. Brenner DJ, Hall EJ: Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007, 357:2277–2284.

    Article  CAS  PubMed  Google Scholar 

  17. Anderson SW, Zajick D, Lucey BC, et al.: 64-Detector row computed tomography: An improved tool for evaluating the biliary and pancreatic ducts? Curr Probl Diagn Radiol 2007, 36:258–271.

    Article  PubMed  Google Scholar 

  18. Chopra S, Chintapalli KN, Ramakrisna K, et al.: Helical CT cholangiography with oral cholecystographic contrast material. Radiology 2000, 21:596–601.

    Google Scholar 

  19. Prpic GL, Babie N, Marjan D, et al.: MR assessment of bile duct size in healthy individuals: comparison with US measurements. Coll Antropol 2007, 2:567–571.

    Google Scholar 

  20. Graham MG, Cooperberg PL, Cohen MM, et al.: The size of the normal common hepatic duct following cholecystectomy: an ultrasonographic study. Radiology 1980, 135:137–139.

    CAS  PubMed  Google Scholar 

  21. Mueller PR, Ferrucci JT, Simeone JF, et al.: Postcholecystectomy bile duct dilatation: myth or reality? AJR Am J Roentgenol 1981, 136:355–358.

    CAS  PubMed  Google Scholar 

  22. Feng B, Song Q: Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients. AJR Am J Roentgenol 1995, 165:895–861.

    Google Scholar 

  23. Cohen SM, Kurtz AB: Biliary sonography. Radiol Clin North Am 1991, 29:1171–1198.

    CAS  PubMed  Google Scholar 

  24. Yamaguchi M: Congenital choledochal cyst. Analysis of 1433 patients in the Japanese literature. Am J Surg 1980, 14:653–657.

    Article  Google Scholar 

  25. Gigot J, Nagorney D, Farnell M, et al.: Bile duct cysts: a changing spectrum of presentation. J Hepatobiliary Pancreat Surg 1996, 3:405–411.

    Article  Google Scholar 

  26. Babbitt D: Congenital choledochal cysts: new etiological concept based on anomalous relationships of common bile duct and pancreatic bulb. Ann Radiol (Paris) 1969, 12:231–240.

    CAS  Google Scholar 

  27. Todani T, Watanabe Y, Narusue M, et al.: Congenital choledochal cysts. Classification, operative procedures, and review of thirty-seven cases including cancer arising from a choledochal cyst. Am J Surg 1977, 13:263–269.

    Article  Google Scholar 

  28. Todani T, Watanabe Y, Toki A, et al.: Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 2003, 10:340–344.

    Article  PubMed  Google Scholar 

  29. Irwin ST, Morison JE: Congenital cyst of the common bile duct containing stones and undergoing cancerous change. Br J Surg 1944, 32:319–321.

    Article  Google Scholar 

  30. • Soreide K, Soreide JA: Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol 2007, 14:1200–1211. This article reviews the classification, etiology, surgical management, and theories for malignant transformation in bile duct cysts.

  31. Kobayashi S, Asano T, Yamasaki M, et al.: Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery 1999, 12:939–944.

    Article  Google Scholar 

  32. Voyles CR, Smadja C, Shands C, et al.: Carcinoma in choledochal cysts: age related incidence. Arch Surg 1983, 118:986–988.

    CAS  PubMed  Google Scholar 

  33. • Garrow D, Miller S, Sinha D, et al.: Endoscopic ultrasound: a meta-analysis of test performance in suspected biliary obstruction. Clin Gastroenterol Hepatol 2007, 5:616–623. This article is a meta-analysis of the accuracy of EUS in identifying the etiology of biliary obstruction, with inclusion of 36 relevant publications.

  34. Tse F, Liu L, Barkun AN, et al.: EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc 2008, 67:235–244.

    Article  PubMed  Google Scholar 

  35. •• Kondo S, Isayama H, Akahane M, et al.: Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography. Eur J Radiol 2005, 54:271–275. A prospective, blinded study where each patient with high probability of choledocholithiasis underwent evaluation with EUS, MRCP, CT, and ERCP. All modalities achieved high sensitivity and accuracy when compared with the ERCP gold standard. The study is remarkable for the prospective approach, and ability to directly compare all four evaluation modalities in the same patients.

  36. • Fernandez-Esparrach G, Gines A, Sanchez M, et al.: Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study. Am J Gastroenterol 2007, 102:1632–1639. This prospective study evaluated patients with either unexplained biliary dilatation or normal bile duct diameter but high suspicion for choledocholithiasis. Both EUS and MRCP were highly accurate in diagnosing pathology in both groups of patients.

    Google Scholar 

  37. Karakan T, Cindoruk M, Alagozlu H, et al.: EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a prospective randomized trial. Gastrointest Endosc 2009, 69:244–252.

    Article  PubMed  Google Scholar 

  38. Scheiman JM, Carlos RC, Barnett JL, et al.: Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol 2001, 96:2900–2904.

    Article  CAS  PubMed  Google Scholar 

  39. Hekimoglu K, Ustundag Y, Abdurrahim D, et al.: MRCP vs ERCP in the evaluation of biliary pathologies: review of the current literature. J Dig Dis 2008, 9:162–169.

    Article  PubMed  Google Scholar 

  40. Shanmugam V, Beattie GC, Yule SR, et al.: Is magnetic resonance cholangiopancreatography the new gold standard in biliary imaging? Br J Radiol 2005, 78:888–893.

    Article  CAS  PubMed  Google Scholar 

  41. Kaltenthaler EC, Walters SJ, Chilcott J, et al.: MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006, 6:1–15.

    Article  Google Scholar 

  42. Kim JE, Lee JK, Lee KT, et al.: The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography. Endoscopy 2001, 33:495–500.

    Article  CAS  PubMed  Google Scholar 

  43. •• Malik S, Kaushik N, Khalid A, et al.: EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes. Dig Dis Sci 2007, 52:508–512. This study addresses a key issue in modern medicine: What to make of the incidentally identified marginally dilated bile duct in patients asymptomatic from a biliary standpoint? In this retrospectively evaluated patient population, the yield of EUS was very low (6%), as opposed to an expected higher yield in patients with abnormal hepatic biochemistries (53%).

  44. Hammarström L-E: Is there significant increase in bile duct width after cholecystectomy? Scand J Gastroenterol 1997, 32:961–964.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Avenue, Iowa, IA, 52242, USA

    Adrian N. Holm & Henning Gerke

Authors
  1. Adrian N. Holm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henning Gerke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henning Gerke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holm, A.N., Gerke, H. What Should Be Done with a Dilated Bile Duct?. Curr Gastroenterol Rep 12, 150–156 (2010). https://doi.org/10.1007/s11894-010-0094-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-010-0094-3

Keywords

Search

Navigation