Abstract
Background and aim
Increased common bile duct (CBD) diameter has been attributed to aging and previous cholecystectomy. These relationships are, however, controversial and based mainly on old studies and methodologies. Our objective is to evaluate the relationship between age, cholecystectomy, and other clinical factors and CBD diameter, as measured by endoscopic ultrasound (EUS).
Methods
We carried out a retrospective cohort study including patients who underwent EUS in our institution. Patients with an obstructing lesion of the bile ducts, previous sphincter manipulation, or insufficient data were excluded. CBD diameter was measured as a routine part of the examination, in the most distal extrapancreatic portion, between its two exterior margins. The patients were divided into five age groups. The mean CBD diameter in each group was calculated and compared with the other groups. Effects of cholecystectomy, gender, time from operation, and elevated liver enzymes were also evaluated.
Results
Six hundred forty-seven patients were included in the study (66 % women). Twenty-three percent were postcholecystectomy. There was no difference between the first three groups regarding CBD diameter, but it was significantly wider in groups 4 and 5 (p < 0.001). In all age groups, the postcholecystectomy patients had significantly wider CBD than those with an intact gallbladder (in all groups, p < 0.01).
Conclusions
This EUS study confirms that the CBD dilates significantly after the age of 70 years, but even in the most elderly patients, with an intact gallbladder, the normal CBD does not exceed 7.6 mm, thus a wider CBD warrants further investigation. The single additional factor contributing to dilatation of the CBD was cholecystectomy. A linear regression equation is proposed for the prediction of CBD diameter.
Similar content being viewed by others
References
Reinus WR, Shady K, Lind M et al (1992) Ultrasound evaluation of the common bile duct in symptomatic and asymptomatic patients. Am J Gastroenterol 87:489–492
Campbell WL, foster RG, Miller WJ et al (1992) Changes in extrahepatic bile duct caliber in liver transplant recipients without evidence of biliary obstruction. AJR 158:997–1000
Rajnakova A, goh PM, Ngoi SS, Lim SG (2003) ERCP in patients with periampullary diverticulum. Hepatogastroenterology 50:625–628
Wu CC, Ho YH, Chen CY (1984) Effect of aging on CBD diameter: a real-time ultrasonographic study. J Clin Ultrasound 12:473–478
Kaim A, Steinke K, Frank M et al (1998) Diameter of the common bile duct in elderly patients: measurements by ultrasound. Eur Radiol 8:1413–1415
Perret RS, Sloop GD, Borne JA (2000) Common bile duct measurements in an elderly population. J Ultrasound Med 19:727–730
Horrow MM, Horrow JC, Niakosari A et al (2001) Is age associated with size of the adult extrahepatic bile duct: sonographic study. Radiology 221:411–414
Bahar GN, Cohen M, belenky A et al (2003) Effect of aging on the adult extrahepatic bile duct––a sonographic study. J Ultrasound Med 22:879–882
Oddi R (1887) D’une disposition a sphincter special de l’ouverture du canal cholodoque. Arch Ital Biol 8:317–322
Judd ES (1923) Condition of the common bile duct after cholecystectomy. JAMA 81:704–709
Hunt DR, Scott AJ (1989) Changes in bile duct diameter after cholecystectomy: a 5-year prospective study. Gastroenterology 97(6):1485–1488
Csendes PG, Csendes AJ, burgos AML et al (2007) Prospective study of common bile duct diameter 12 years after a cholecystectomy. Rev Med Chile 135:735–742
Chawla S, Trick WE, Gilkey S et al (2010) Does cholecystectomy status influence the common bile duct diameter? A matched-pair analysis. Dig Dis Sci 5594:1155–1160
Polkowski M, Palucki J, Regula J et al (1999) Helical computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients. Gut 45:744–749
Alvarez-Sanchez MV, Pujol B, Napoleon B (2009) Linear array EUS in bile duct lesions. Gastrointest Endosc 69(2):s121–s124
Lawson TL (1994) The biliary ductal system. In: Putman CE, Ravin CE (eds) Textbook of diagnostic imaging, 2nd edn. WB Saunders, Philadelphia, pp 908–942
Zwiebel WJ (1998) The biliary system: sonographic technique and anatomy. In: Sohaey R, Zwiebek Wj (eds) Introduction to ultrasound. Philadelphia, WB Saunders, pp 122–131
Sample WF, Sarti DA, Goldstein LI et al (1978) Gray-scale ultrasonography of the jaundiced patient. Radiology 128:719–725
Cooperberg PL (1978) High-resolution real-time ultrasound in the evaluation of the normal and obstructed biliary tract. Radiology 128:477–480
Parulekar SG (1979) Ultrasound evaluation of the common bile duct size. Radiology 133:703–707
Niedrau C, Muller J, Sonnenberg A et al (1983) Extrahepatic bile ducts in healthy subjects, in patients with cholelithiasis, and in postcholecystectomy patients: a prospective ultrasonic study. J Clin Ultrasound 11:23–27
Kaude JV (1983) The width of the common bile duct in relation to age and stone disease: an ultrasonographic study. Eur J Radiol 3:115–117
Hernandez-Schulamn M, Ambrosino MM, Freeman PC, Quinn CB (1995) Common bile duct in children: sonographic dimensions. Radiology 195:193–195
Senturk S, Miroglu TC, Bilici A, et al. Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT. Eur J Radiol. In press (accepted Nov 2010)
Takahashi Y, Takahashi T, Takahashi W et al (1985) Morphometric evaluation of the extra hepatic bile ducts in reference to their structural changes with aging. Tohoko J Exp Med 147:301
Nahada A (1981) Changes in morphology of the distal CBD associated with aging. Gastroenterology Jpn 16(1):54–63
Feng B, Song Q (1995) Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients. AJR 165:859–861
Acknowledgments
This study was presented in part as a distinguished poster during the Digestive Disease Week in Chicago May 10th, 2011 (Gastroenterology 2011; 140 (5): s-749).
Disclosures
Drs. Fabiana Benjaminov, George Leichtman, Timna Naftali, Elizabeth E. Half, and Fred M Konikoff have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Benjaminov, F., Leichtman, G., Naftali, T. et al. Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography. Surg Endosc 27, 303–307 (2013). https://doi.org/10.1007/s00464-012-2445-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2445-7