Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1289
Peer-review started: August 2, 2020
First decision: September 30, 2020
Revised: October 12, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: December 27, 2020
Processing time: 137 Days and 14 Hours
Bile duct dilation is often related to an obstructive process such as a stone, stricture or a mass. The role of other patient factors such as height, weight, body mass index, and substance use in modulating biliary dilation have not been well defined.
In the past two decades, both opiate use/dependence and utilization of cross-sectional abdominal imaging have sharply increased. We have noted an increase in referrals to our academic tertiary care medical center for incidentally detected biliary dilation, particularly in patients who use opiates.
Our goal was to evaluation associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index to understand how these factors may be related to biliary dilation.
We evaluated associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index utilizing our institution’s integrated informatics platform. We evaluated 1685 Emergency Department patients (a 20% sample from 2011-2016) who had undergone cross-sectional abdominal imaging and had normal total bilirubin.
Diameter of the common bile duct was significantly higher in opiate users compared to non-opiate users (8.67 mm vs 7.24 mm, P < 0.001) and in patients with a history of cholecystectomy compared to those with an intact gallbladder (8.98 vs 6.72, P < 0.001). For patients with an intact gallbladder who did not use opiates (n = 432), increasing age did not predict common bile duct (CBD) diameter (r2 = 0.159, P = 0.873).
A history of cholecystectomy and opiate use are associated with common bile duct dilation in the absence of an obstructive process. Age alone does not appear to be associated with increased common bile duct diameter.
These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter. Future prospective study would be desirable to expand upon these findings.