The common duct dilates after cholecystectomy and with advancing age: reality or myth?

• Published in: Journal of ultrasound in medicine 2013-08, Vol.32 (8), p.1385-1391
• Main Authors: McArthur, Tatum A, Planz, Virginia, Fineberg, Naomi S, Tessler, Franklin N, Robbin, Michelle L, Lockhart, Mark E
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alabama - epidemiology; Cholecystectomy - statistics & numerical data; Common Bile Duct - diagnostic imaging; Common Bile Duct - pathology; Common Bile Duct Diseases - diagnostic imaging; Common Bile Duct Diseases - epidemiology; Dilatation, Pathologic; Female; Humans; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Prevalence; Reproducibility of Results; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Single-Blind Method; Treatment Outcome; Ultrasonography - statistics & numerical data; Young Adult
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/ultra.32.8.1385

To evaluate changes in the common duct diameter on sonography over time in patients with and without cholecystectomy. We retrospectively evaluated the common duct diameter, central biliary dilatation, and interval change in 1079 patients who underwent sonography at least 2 years apart over a 6-year period. A board-certified radiologist, blinded to clinical and laboratory data, measured the duct diameter. A total of 893 patients (568 female and 325 male) were divided into 3 groups: group 1, remote cholecystectomy before sonography (mean, 9.7 years before sonography; n = 117); group 2, interval cholecystectomy between the first and second sonographic examinations (n = 56); and group 3, no cholecystectomy (n = 720). All groups were stratified by age, and group 3 was also stratified by the absence (n = 528) or presence (n=192) of gallstones. Duct diameters at baseline and follow-up averaged 4.5 and 5.2, 3.6 and 4.9, and 3.5 and 3.9 mm in groups 1, 2, and 3, respectively. Group 1 ducts were larger at baseline than in the other groups (P < .001). At follow-up, group 2 ducts showed a greater interval diameter increase than the other groups (P < .001). In a subanalysis of each group based on age, there was a mild increase in duct size with increasing age, although not clinically significant and within normal limits. In group 3 patients who never had gallstones, there was a significant small increase in duct size over decades (P < .001). The baseline duct sizes for patients with gallstones were not significantly different from those who never had gallstones (P = .15). Patients with remote cholecystectomy have larger common duct diameters than those with no or interval cholecystectomy. Most asymptomatic patients with or without cholecystectomy have a normal common duct diameter.