Endosonography for Pancreatic Duct Dilatation without Definite Pathology on Ultrasonography

摘要

Background/Aims: Main pancreatic duct dilatation raises concerns about the possibility of pancreato-biliary malignancy. We evaluated the etiologic yield of endosonography (EUS) for main pancreatic duct dilatation without definite pathology on Ultrasonography (US). Methodology: A retrospective review was conducted in 54 consecutive patients referred for EUS. Results: No pathological finding (37.0%, 20/54), followed by periampullary cancer (35.2%, 19/54), was the most common finding. Elevated alkaline phospha-tase (ALK-P) and marked common bile duct (CBD) dilatation (^ 12 mm) were the predictors of malignancy (p< 0.05). Among the 37 subjects with available ALK-P and CBD diameter, the probability of malignancy was84.6% (11/13) for both elevated ALK-P and marked CBD dilatation, 16.7% (1/6) for isolated elevated ALK-P, 18.2% (2/11) for isolated marked CBD dilatation, and none (0/7) was for subjects with neither elevated ALK-P nor marked CBD dilatation, respectively. The overall accuracy of EUS for periampullary carcinomas was 94.7% (18/19) and for choledocholithiasis was 100% (7/7), respectively. EUS had a 100.0% (20/20) sensitivity and a 97.1% (33/34) specificity in the diagnosis of no pathological obstruction. Conclusions: EUS is accurate for main pancreatic duct dilatation without definite pathology on US, and the presence of concomitant elevated ALK-P and CBD dilatation highly suggests malignancy.