Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

• Published in: World journal of surgery 2021-09, Vol.45 (9), p.2712-2718
• Main Authors: Saluja, Sundeep Singh, Varshney, Vaibhav Kumar, Bhat, Vidya Sharada, Nekarakanti, Phani Kumar, Arora, Asit, Sachdeva, Sanjeev, Mishra, Pramod Kumar
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Algorithms; Alkaline phosphatase; Bile ducts; Bilirubin; Cardiac Surgery; Cholecystectomy; General Surgery; Liver; Medicine; Medicine & Public Health; Pancreaticoduodenectomy; Pancreatitis; Patients; Surgery; Surgery in Low and Middle Income Countries; Thoracic Surgery; Tumors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-021-06175-4

Objective Dilated common bile duct (CBD) (8–15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years. Methods Seventy-eight such patients were managed from 2009 to 2017 and categorized as: Group A—dilated CBD with post-cholecystectomy status ( n  = 15); B—dilated CBD with cholelithiasis ( n  = 34); C—dilated CBD without cholelithiasis ( n  = 16); D—dilated CBD with no cause identified and underwent CBD excision ( n  = 13). Causes for CBD dilatation were evaluated. The outcome of patients in Group B + C without any cause ( n  = 33) was compared with Group D. Result Median age, CBD diameter, bilirubin and alkaline phosphatase were 51 years (13–79), 10 mm (8–20), 0.6 mg/dl (0.2–2.5) and 126 IU (60–214), respectively. Group-A patients who did not manifest any cause of CBD dilatation were managed conservatively. The aetiology was identified in 17/50 patients in Group B & C [acute pancreatitis ( n  = 6), passed CBD calculi ( n  = 3), perivaterian diverticulum ( n  = 3), viral aetiology ( n  = 4) and tumour (n-1)]. In Group-C, 7 patients with no obvious cause underwent endoscopic sphincterotomy, pancreatoduodenectomy ( n  = 1), and the rest were managed conservatively ( n  = 8). There was no significant difference in the complication between Group B + C (without any cause) and Group D (3/33 vs. 1/13; p  = 0.58) at a median follow-up of 72 months (30–90). Conclusion Dilated CBD with normal LFT’s without apparent cause is mostly benign and of no consequence. Excision of the CBD is not required for most of these patients.