Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):53-58. 10.14701/ahbps.23-063.

Incidental double duct sign: Should we be worried? Results from a long-term follow-up study

• Yao L
• Amar H
• Aroori S

• KMID: 2553366
• DOI: http://doi.org/10.14701/ahbps.23-063

Abstract

Backgrounds/Aims
Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/ peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS.
Methods
 Patients were categorized according to their risk of malignancy. ‘Low-risk’ patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS.
Results
 Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for ‘low-risk’ patients was 7.3 years (range, 6–11 years). The mean number of follow-up investigations per patient was two (range, 0–9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (p < 0.01). Those with abdominal pain were more likely to have a benign cause (p < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (p < 0.01).
Conclusions
 Patients with I-DDS have a low risk of developing PHPAT within five years.

Keyword

Double duct sign; Incidental; Malignancy; Follow-up

Figure

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  Fig. 1 Double duct sign on magnetic resonance cholangiopancreatography imaging. CBD, common bile duct; PD, pancreatic duct.

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  Fig. 2 Double duct sign on computed tomography imaging. PD, pancreatic duct; CBD, common bile duct.

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  Fig. 3 Patient flow diagram. HPB, hepatopancreatobiliary; DDS, double duct sign.

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  Fig. 4 Proposed investigation pathway for patients with incidental DDS. DDS, double duct sign; LFT, liver function test; MRCP, magnetic resonance cholangiopancreatography; MDT, multidisciplinary team; CEA, carcinoembryonic antigen; EUS, endoscopic ultrasound.

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