Common Bile Duct Measurements: Not very useful for emergency physicians

Editors note:

Lloyd has provided several great biliary scans to the blog and in his previous CBD related post talked about how an incidental finding of dilated CBD helped guide him towards diagnosing a patient with pancreatic cancer.  While all of us at the EDE blog are POCUS enthusiasts, we must acknowledge that there is growing evidence to support some applications over others.  I think it’s important to provide a balanced perspective on the usefulness of CBD imaging in general for emergency physicians, especially for the novice.

At our courses we de-emphasize beginners trying to visualize the CBD for several reasons:

1. Developing competence at gallbladder imaging requires a fair amount of practice and adding the CBD significantly increases the time commitment at the bedside.

2. Unlike the gallbladder, emergency physicians don’t do a great job at accurately measuring the CBD.  So incorporating this data point into clinical decision making is problematic.

3. CBD measurements don’t make a big difference to our acute management of biliary colic in the emergency department.

So why load the novice with the work of learning a scan that has questionable accuracy and usefulness at the bedside, particularly when they must expend significant effort just learning to generate gallbladder scans?

As the study below demonstrates, it’s currently a low yield exercise perhaps better left to the very experienced POCUS practitioner or radiologist.

J Emerg Med Jan 2014 Emergency biliary sonography: utility of common bile duct measurement in the diagnosis of cholecystitis and choledocholithiasis.

Lloyd has a nice example of how easy it can be to see dilated CBD’s but as he demonstrates with his next case, it didn’t impact management.

[Ed.]

Just to show that you can see the CBD without too much trouble, especially if it’s dilated. In this case it was just post-cholecystectomy. No pathology.