From the Guidelines
Common bile duct dilation is most commonly caused by gallstones obstructing the duct, tumors, chronic pancreatitis, primary sclerosing cholangitis, and post-surgical strictures, as evidenced by recent guidelines and studies 1. The condition is typically discovered incidentally during imaging studies like ultrasound, CT scan, or MRI, and patients may be asymptomatic or present with symptoms like jaundice, abdominal pain, nausea, vomiting, or fever if there is an underlying obstruction or infection.
Key Causes and Considerations
- Gallstones obstructing the duct
- Tumors (such as pancreatic cancer or cholangiocarcinoma)
- Chronic pancreatitis
- Primary sclerosing cholangitis
- Post-surgical strictures Evaluation should include liver function tests, additional imaging such as MRCP (magnetic resonance cholangiopancreatography), and potentially ERCP (endoscopic retrograde cholangiopancreatography) for both diagnosis and treatment, as recommended by recent clinical practice guidelines 1.
Management Approach
- Management depends on the underlying cause
- Gallstones may require ERCP with sphincterotomy and stone extraction
- Malignant obstructions might need stent placement or surgery
- Asymptomatic dilation without an identifiable cause may simply require monitoring with periodic imaging and liver function tests Prompt evaluation is important as untreated biliary obstruction can lead to serious complications including cholangitis (bile duct infection) and secondary biliary cirrhosis, highlighting the need for timely and appropriate intervention based on the most recent evidence 1.
From the Research
Causes of Common Bile Duct (CBD) Dilation
- Obstruction, lesions, and compression are common causes of secondary intra- and extrahepatic bile duct dilatation 2
- Biliary strictures, stones, and cholangiocarcinoma can lead to CBD dilation 2
- Post-cholecystectomy status, cholelithiasis, and no identifiable cause are also possible reasons for CBD dilation 3
- Acute pancreatitis, passed CBD calculi, perivaterian diverticulum, viral aetiology, and tumour can also contribute to CBD dilation 3
Classification of CBD Dilation
- Clinicopathological perspective: obstruction-, lesion-, and compression-induced dilatation 2
- Etiological classification: various diseases can cause secondary intra- and extrahepatic bile duct dilatation 2
Treatment Strategies
- Endoscopic dilation or stenting for biliary strictures 2
- Laparoscopic choledochectomy for stone removal 2
- Resection for cholangiocarcinoma 2
- Conservative management for patients with no identifiable cause of CBD dilation 3
- Endoscopic sphincterotomy, pancreatoduodenectomy, or conservative management for patients with no obvious cause of CBD dilation 3