Ankit Chhoda1, Sanad Dawod2, Alyssa Grimshaw3, Craig Gunderson4, SriHari Mahadev5. 1. Research Fellow, Section of Digestive Diseases, Yale School of Medicine Digestive Diseases, LMP 1080, 15 York Street, New Haven, CT, 06510. 2. Research Fellow, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York NY 10065. 3. Clinical Research and Education Librarian, Yale Harvey Cushing/ John Hay Whitney Medical Library, 333 Cedar St. New Haven, CT 06510. 4. Associate Professor, Section Chief, Hospital Medicine, Associate Firm Chief, Department of Medicine, VA Connecticut Healthcare System, PO Box 208056, 333 Cedar Street, New Haven, CT, 06520-8056. 5. Assistant Professor of Medicine, Weill Cornell Medical College.. Electronic address: srm9005@med.cornell.edu.
Abstract
BACKGROUND AND AIMS: Common bile duct (CBD) dilation is a frequent indication for endoscopic ultrasound (EUS). Among asymptomatic individuals, biliary dilation may not be clinically significant; however, EUS is often relied upon for the exclusion of benign and malignant pathology that might require further intervention. The yield of EUS evaluation for this indication is not well characterized and has significant implications for health resource utilization because asymptomatic biliary dilation is prevalent. Through this systematic review, we sought to appraise the yield of EUS evaluation of asymptomatic patients with radiologic evidence of isolated CBD dilation. METHODS: A protocolled search (PROSPERO: CRD42020193428) extracted original studies from Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, Pubmed, Scopus, and Web of Science Core Collection which described diagnostic yield of EUS among asymptomatic patients with biliary dilation. Cumulative EUS diagnostic yield was calculated through meta-analysis of proportions using inverse variance methods and a random effect model. RESULTS: Of 2616 studies, 8 delineated the EUS yield among 224 asymptomatic patients. The cumulative yield of EUS for any pathology was 11.2% (95% CI, 3.6%- 21.6%). EUS yielded benign etiologies in 9.2% (95% CI, 1.1%-21.9%), of which choledocholithiasis comprised 3.4% (95% CI, 0%-11.2%), and malignant etiologies among 0.5% (95% CI, 0%-3.4%) of the cases. CONCLUSIONS: EUS in patients with asymptomatic CBD dilation does yield findings of choledocholithiasis and malignancy, albeit at low rates. Cost-effectiveness analysis is warranted to further guide clinical decision-making in this area.
BACKGROUND AND AIMS: Common bile duct (CBD) dilation is a frequent indication for endoscopic ultrasound (EUS). Among asymptomatic individuals, biliary dilation may not be clinically significant; however, EUS is often relied upon for the exclusion of benign and malignant pathology that might require further intervention. The yield of EUS evaluation for this indication is not well characterized and has significant implications for health resource utilization because asymptomatic biliary dilation is prevalent. Through this systematic review, we sought to appraise the yield of EUS evaluation of asymptomatic patients with radiologic evidence of isolated CBD dilation. METHODS: A protocolled search (PROSPERO: CRD42020193428) extracted original studies from Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, Pubmed, Scopus, and Web of Science Core Collection which described diagnostic yield of EUS among asymptomatic patients with biliary dilation. Cumulative EUS diagnostic yield was calculated through meta-analysis of proportions using inverse variance methods and a random effect model. RESULTS: Of 2616 studies, 8 delineated the EUS yield among 224 asymptomatic patients. The cumulative yield of EUS for any pathology was 11.2% (95% CI, 3.6%- 21.6%). EUS yielded benign etiologies in 9.2% (95% CI, 1.1%-21.9%), of which choledocholithiasis comprised 3.4% (95% CI, 0%-11.2%), and malignant etiologies among 0.5% (95% CI, 0%-3.4%) of the cases. CONCLUSIONS: EUS in patients with asymptomatic CBD dilation does yield findings of choledocholithiasis and malignancy, albeit at low rates. Cost-effectiveness analysis is warranted to further guide clinical decision-making in this area.