Ann Geriatr Med Res.  2016 Dec;20(4):177-184. 10.4235/agmr.2016.20.4.177.

Association Between Extrahepatic Duct Diameter on Abdominal Computed Tomography and Severity Classified Using Tokyo Guidelines 2013 in Elderly Patients With Cholangitis

• Kim HS
• Lee CM
• Ko BS
• Park SH
• Jung W
• Kim MC
• Ko YG

• KMID: 2415676
• DOI: http://doi.org/10.4235/agmr.2016.20.4.177

Abstract

BACKGROUND
It is important to estimate the severity of early stage cholangitis in elderly patients to determine the most appropriate timing of biliary decompression. Abdominal computed tomography (CT) is the modality of choice for the diagnosis of cholangitis; however, studies evaluating the correlation between cholangitis severity and CT findings, specifically extrahepatic duct (EHD) diameter, are insufficient. Therefore, this study aimed to evaluate the relationship between EHD diameter and disease severity in elderly patients with cholangitis.
METHODS
A total of 155 patients over the age of 65 years, admitted to the Emergency Department, with a diagnosis of cholangitis from January 2010 to December 2015 were retrospectively analyzed. Using the Tokyo Guidelines 2013, patients were grouped into mild and moderate to severe cholangitis groups. We then analyzed the patient's medical backgrounds, vital signs, and CT findings. To evaluate the significance of the CT findings in relation to cholangitis severity, a univariate analysis was performed within each group, using the collected variables. A multiple logistic regression analysis was performed using the variables with p<0.05.
RESULTS
On univariate analysis, EHD diameter (p<0.001) and combined cholecystitis (p=0.009) were found to be significant CT findings; EHD diameter (odds ratio [OR], 1.235; 95% confidence interval [CI], 1.115-1.368; p<0.001) and combined cholecystitis (OR, 2.666; 95% CI, 1.145-6.212; p=0.023) were also statistically significant after multiple logistic regression.
CONCLUSION
In conclusion, increased EHD diameter was associated with disease severity in elderly patients with cholangitis. EHD diameter is easy to measure on CT and can be helpful in establishing an appropriate treatment plan.

Keyword

Cholangitis; Computed tomography; Geriatrics; Severity; Bile ducts

MeSH Terms

Aged*
Bile Ducts
Cholangitis*
Cholecystitis
Decompression
Diagnosis
Emergency Service, Hospital
Geriatrics
Humans
Logistic Models
Retrospective Studies
Vital Signs