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In the present study, we investigated a new sonographic test to confirm or exclude partial common bile duct (CBD) obstruction, hereinafter called “dynamic cholangio-cholecysto sonography (DCCS).” Healthy controls (6) and patients with low- to intermediate probability for partial CBD obstruction (17) were investigated. DCCS started with three baseline masurements of gallbladder volume and CBD diameter, which were then repeated every 2 to 3 min for 45 min during a 30-min infusion of ceruletid. According to CBD diameter change during gallbladder contraction, DCCS was considered positive (> 1 mm), negative (< 0.5 mm) or equivocal (remainder). After DCCS, all patients underwent endoscopic retrograde cholangiography (ERCP) and all but one patient had endoscopic sphincterotomy (EST). A follow-up examination was performed at least 4 weeks after ERCP. Based on these results, an outcome score was calculated to classify the patients as having a flow-relevant CBD obstruction or not. DCCS was true positive in 4 patients (sensitivity 66%, positive predictive value 100%). DCCS was false-negative in 1 patient and equivocal in another patient. DCCS was true-negative in 9 patients (specifity 82%, negative predictive value 90%). Two patients without flow-relevant CBD obstruction had equivocal DCCS test results. DCCS might be used as a noninvasive test for further workup of patients with low- to intermediate probability of flow relevant CBD obstruction, helping to avoid unnecessary ERCP and to serve as an additional indication for ERCP and EST.
The common bile duct (CBD) was measured in 600 ultrasound studies. In normal patients the mean width of the CBD increased from 2.8 mm in the age group 20 years or younger to 4.1 mm in patients 71 years of age or older. The mean width of the CBD for all age groups in normal cases was 3.4 (range 2 to 11 mm). In presence of cholelithiasis the mean width of the CBD was 4.5 mm (range 2 to 15 mm). There was no further increase of the CBD after cholecystectomy (mean width 4.6 mm, range 2 to 12 mm). The CBD in patients with hepatocellular disease was wider than normals (mean 4.4 mm) and markedly increased in patients with pancreatic disease (mean 6.2 mm, range 2 to 21 mm) due to obstruction in several cases.