Evaluation of diagnostic yield of EUS among patients with asymptomatic common bile duct dilation: systematic review and meta-analysis.

Overview

abstract

BACKGROUND AND AIMS: Common bile duct (CBD) dilation is a frequent indication for endoscopic ultrasound (EUS). Among asymptomatic individuals, biliary dilation may not be clinically significant; however, EUS is often relied upon for the exclusion of benign and malignant pathology that might require further intervention. The yield of EUS evaluation for this indication is not well characterized and has significant implications for health resource utilization because asymptomatic biliary dilation is prevalent. Through this systematic review, we sought to appraise the yield of EUS evaluation of asymptomatic patients with radiologic evidence of isolated CBD dilation. METHODS: A protocolled search (PROSPERO: CRD42020193428) extracted original studies from Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, Pubmed, Scopus, and Web of Science Core Collection which described diagnostic yield of EUS among asymptomatic patients with biliary dilation. Cumulative EUS diagnostic yield was calculated through meta-analysis of proportions using inverse variance methods and a random effect model. RESULTS: Of 2616 studies, 8 delineated the EUS yield among 224 asymptomatic patients. The cumulative yield of EUS for any pathology was 11.2% (95% CI, 3.6%- 21.6%). EUS yielded benign etiologies in 9.2% (95% CI, 1.1%-21.9%), of which choledocholithiasis comprised 3.4% (95% CI, 0%-11.2%), and malignant etiologies among 0.5% (95% CI, 0%-3.4%) of the cases. CONCLUSIONS: EUS in patients with asymptomatic CBD dilation does yield findings of choledocholithiasis and malignancy, albeit at low rates. Cost-effectiveness analysis is warranted to further guide clinical decision-making in this area.