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      Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

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          Abstract

          BACKGROUND

          Adenomyomatous hyperplasia of the distal common bile duct (CBD) is very rare, with only scarce case reports in the literature. Diagnosis is usually based on imaging findings, and endoscopic biopsy is very difficult before operation. It is believed that adenomyomatous hyperplasia has little or no risk of malignant transformation.

          CASE SUMMARY

          A 68-year-old woman with abdominal pain in the right upper quadrant was referred to our hospital. Abdominal ultrasonography in the emergency ward revealed acute cholecystitis and dilated CBD. Laboratory findings showed elevated levels of transaminases, phosphatase, and γ-glutamyltranspeptidase. Pharmaceutical treatment for 3 d did not relieve the symptoms. Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) showed proximal bile duct dilatation but could not identify the cause. Endoscopic ultrasonography (EUS) demonstrated a mixed echogenic mass in the distal CBD. During surgery, a firm mass was found in the distal CBD and the Whipple procedure was performed with the initial concern of malignancy. Histology showed diffuse adenomyomatous hyperplasia.

          CONCLUSION

          EUS may be a useful choice to diagnose adenomyoma of the distal CBD before operation, especially in patients with ambiguous MRCP/CT findings.

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          Most cited references29

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          Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis.

          Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity.
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            ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas.

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              EUS: a meta-analysis of test performance in suspected choledocholithiasis.

              EUS has been proposed as a less invasive means of diagnosing choledocholithiasis and may eliminate the need for ERCP and its associated risks. The literature pertaining to EUS for the diagnosis of choledocholithiasis reports widely varying sensitivities and specificities. To more precisely estimate the diagnostic accuracy of EUS in suspected choledocholithiasis. MEDLINE and EMBASE databases were used to identify prospective cohort studies in which the results of EUS were compared with the results of an acceptable criterion standard, including ERCP, intraoperative cholangiography, or surgical exploration. Two independent reviewers extracted standardized data and assessed trial quality. A random effects model was used to estimate the sensitivity, specificity, likelihood, and diagnostic odds ratio (DOR), and a summary receiver operating characteristic curve was constructed. All predefined potential sources of heterogeneity were explored by subgroup analysis and meta-regression. A total of 2673 patients with suspected choledocholithiasis were reported in 27 studies that satisfied the inclusion criteria. EUS had a high overall pooled sensitivity of 0.94 (95% CI, 0.93-0.96), a specificity of 0.95 (95% CI, 0.94-0.96), and an area under the curve of 0.98. Three variables appeared to yield a higher DOR: a higher disease prevalence, an adequate time interval between index test and criterion standards, and the presence of verification bias. Misclassification of patients by imperfect criterion standards could potentially underestimate the performance of an EUS. An EUS is a noninvasive test, with excellent overall sensitivity and specificity for diagnosing choledocholithiasis. An EUS should, therefore, be used to select patients for a therapeutic ERCP to minimize the risk of complications associated with unnecessary diagnostic ERCP.
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                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                6 November 2019
                6 November 2019
                : 7
                : 21
                : 3615-3621
                Affiliations
                Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
                Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China. huduanmins@ 123456126.com
                Endoscopy Center, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
                Department of Hepatological Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
                Department of Hepatological Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
                Imaging Department, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
                Author notes

                Author contributions: Xu LM was responsible for interpretation of the clinical data and drafting of the manuscript; Hu DM conceived the case report and revised the manuscript; Tang W revised the manuscript for important intellectual content; Wei SH and Chen W were in charge of the operation; Chen GQ provided the figures showing the computed tomography and magnetic resonance imaging findings.

                Supported by The Program for Diagnostic and Therapeutic Technique of Clinically Important Disease in Suzhou , No. LCZX201707; and Program for GUSU Medicine Talents, No. GSWS2019012.

                Corresponding author: Duan-Min Hu, PhD, Chief Doctor, Director, Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou 215004, Jiangsu Province, China. huduanmins@ 123456126.com

                Telephone: +86-512-66784805

                Article
                jWJCC.v7.i21.pg3615
                10.12998/wjcc.v7.i21.3615
                6854403
                31750345
                458f3d11-eeb5-446f-8e77-b60423c9e4d0
                ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 4 July 2019
                : 20 September 2019
                : 5 October 2019
                Categories
                Case Report

                adenomyoma,common bile duct,endoscopic ultrasound,diagnosis,case report

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