Caliber of the common bile duct: effect of cholecystectomy and other factors in a ultrasonographic study of 8534 patients.

OBJECTIVE: The objective of the present study was to analyze the effects of different factors impacting the caliber of the common bile duct (CBD) and a comparison of maximum extrahepatic bile duct caliber in patients with and without a history of cholecystectomy. MATERIAL AND METHODS: A retrospective data analysis was undertaken of 8534 patients (4480 females; 4054 males; average age: 59.2±18.0 years) with sonographic documentation of bile duct caliber. Maximum intra- and extrahepatic bile duct diameters were studied. The normal maximum diameter of the extrahepatic bile duct was defined as 7 mm. In patients who had undergone prior cholecystectomy, a maximum bile duct diameter<10 mm was considered normal. RESULTS: The average maximum diameter of the CBD amounted to 5.3±3.0 mm for the overall collective. In patients who had undergone prior cholecystectomy, maximum CBD diameters in the normal range (<7 mm) were documented in 55%, while larger diameters (>7 mm) were observed in 45%. In the collective of patients without prior cholecystectomy, CBD diameters in the normal range (<7 mm) were found in 81%, with larger diameters observed in only 18.4% of patients. In both subgroups, there was a significant association between age and bile duct diameter (for those with prior cholecystectomy, p=0.0003; without prior cholecystectomy, p<0.0001). No statistically significant influence on CBD diameter was observed for either prior cholecystectomy (p=0.2116) or time interval since cholecystectomy (p=0.3537). Females, both with and without a history of prior cholecystectomy, showed a 1.4-1.5-fold higher risk of exhibiting a CBD diameter>7 mm (for those with prior cholecystectomy, p=0.0485; without prior cholecystectomy, p<0.001). CONCLUSIONS: Our data show a positive correlation between age and CBD diameter. There was no statistically significant relationship between CBD diameter and prior cholecystectomy, postoperative interval and BMI.

Prevalence of risk factors for liver disease in a random population sample in southern Germany.

BACKGROUND: Chronic liver disease leads to fibrosis and cirrhosis of the liver. This may, in turn, result in chronic liver failure or the development of hepatocellular carcinoma (HCC). Main risk factors for chronic liver disease are viral hepatitis and alcoholism. The present study assessed a randomly selected population in southern Germany for risk factors for chronic liver disease such as fatty liver disease, viral hepatis infection and life-style factors. In addition, the potential association with elevated liver enzymes was investigated. METHODS: A total of 2256 subjects (1182 females, 1074 males), aged 18 - 65 years, participated in the study. Each subject underwent a standardized ultrasound examination, and anthropometric and biochemical assessments. Test subjects were randomly selected from the general population of a town in southwestern Germany. Data were acquired from November to December 2002 without further follow-up. RESULTS: Several factors were found to be associated with chronic liver disease in the study population. Alcohol consumption >20 g/d was seen in 18.1% (n=409). Metabolic syndrome was diagnosed in 5.9% (n=132). The number of people with a BMI greater than 25 kg/m(2) was 45.1% (n=1017). The prevalence of subjects with chronic hepatitis B was 0.7% (n=15), that of anti-HCV positive patients, 0.6%(n=15). Elevated gGT was seen in 10.4% (n=14) of the patients. Prevalence of hepatic steatosis was 25.0% (n=564). CONCLUSIONS: Many cases of chronic liver disease could be prevented by healthy nutrition, optimized medical treatment of associated disorders, and prevention strategies such as routine vaccination, in particular, against hepatitis B virus (HBV).

[Ultrasonographically guided biopsy procedures: current practice in hospitals with established departments of gastroenterology]. / Aktuelle Praxis zur Durchführung ultraschallgesteuerter Punktionen an gastroenterologischen Abteilungen.

OBJECTIVE: Ultrasonographically guided adominal biopsies are a frequent daily procedure in German hospitals. There are, however, few guidelines or recommendations for these common procedures. The oive of the current study was to assess current practice with respect to ultrasonographically guided biopsy procedures in a survey of hospitals with established departments of gastroenterology or with over 500 beds. MATERIAL AND METHOD: A questionnaire addressing the preparation for, procedure during, and post-interventional monitoring following ultrasonographically guided biopsies was mailed to 349 German hospitals. The response rate was 51 % (n = 177). RESULTS: Establishment of an intravenous access is standard in 51.2 % (88/172) of the hospitals. Sedation analgesia is standard in 19.1 % (33/173) of the hospitals and is an option in a further 60.1 % (104/173). Local anesthesia is performed in 84.8 % (145/171) of the hospitals. A dedicated transducer for targeted biopsy is used in 40.6 % (81/176) of the hospitals, while 29.5 % (52/176) use a separate biopsy bracket attached to the probe. In 80.6 % (141/175) of the hospitals, a minimum platelet count of 50,000/µL is required. A minimum of 50 % is used as limit for quick in 86.5 % (147/170) of the hospitals. A value of 1 - 1.5 for the international normalized ratio (INR) is most commonly used in the hospitals. A partial thromboplastin time (PTT) between 28 and 50 sec. is used as the upper limit. Interruption of anticoagulants is handled in a very heterogeneous manner. Postinterventional monitoring following biopsy in ambulatory patients ranges from two to 24 hours. CONCLUSION: Our survey shows relevant differences in preparation, execution and postinterventional monitoring in ultrasonographically guided biopsy procedures as routinely performed in German hospitals. There seems to be a need for a guideline standardising ultrasonographically guided biopsy procedures.

[Progress in undergraduate and postgraduate education in abdominal ultrasonography at German university hospitals in 1999-2009]. / Aus- und Weiterbildungssituation in der Abdomensonografie an deutschen Universitätskliniken--Vergleich 1999-2009.

AIM: The aim of this study was to assess the current state of undergraduate and postgraduate education in abdominal ultrasonography at German university hospitals and to compare these findings with data from 1999. METHODS: A survey, encompassing questions related to technical equipment, undergraduate education, graduate education and quality assurance, was conducted at all 36 gastroenterological departments of university hospitals in Germany. The response rate was 86 %. RESULTS: Currently, there is an average of four dedicated ultrasound units for abdominal ultrasonography per department. Two percent are basic units, 12 % are middle-class and 86 % are high-end units. Compared to 1999 there has been an improvement in the quality of ultrasound units but no increase in number; the percentage of high-end units has considerably increased. All departments offer undergraduate training in abdominal ultrasonography. On average, about 100 students per semester take part in training programmes. Ten years ago only 86 % of hospitals provided undergraduate training, for an average of 55 students per semester. Postgraduate training is offered full-time in 94 % of hospitals (1999: 77 %) over a mean time span of 6.1 months (1999: 4.3 months). In 2009a mean of 4.7 physicians per department underwent ultrasonography training, down from 5.6 physicians per department in 1999. CONCLUSION: Over the ten-year observation period, the quality of dedicated ultrasonography equipment for abdominal ultrasonography in the gastroenterological departments of German university hospitals has improved considerably, while the quality of postgraduate education has improved only slightly. In addition, there was improvement in undergraduate ultrasonography training.

[Research activity in abdominal ultrasonography in German university departments of gastroenterology - comparison between 1999 and 2009]. / Forschungssituation in der Abdomensonografie in den gastroenterologischen Abteilungen der Universitätskliniken in der Bundesrepublik Deutschland - Vergleich 1999 - 2009.

AIM: The aim of this study was to generate an overview of the current research situation in abdominal ultrasonography conducted by gasteroenterology departments of German university hospitals and to compare this situation with data from 1999. METHODS: A survey was sent to all 36 German university hospitals encompassing information on research topics, number of research projects and publications, grants, and support by manufacturers of ultrasonography units. The response rate was 86 %. RESULTS: 74 % of gastroenterological departments had 113 ongoing research projects during the enquiry period - on average 3.6 projects per departement. Of these projects 43 % were clinical research, 11 % technical studies, 13 % various topics and 33 % studies with ultrasound contrast enhancers. Ten years ago 80 % of gastroenterological departments had research projects - on average 3.5 projects per department. There was no significant difference in the number of publications between the two enquiry periods. The percentage of publications in English had increased considerably from 57 % (1999) to 78 % (2009). Regarding scientific grants there was no relevant difference during the observed time spans. A total of 32 % (1999: 26 %) of departments receive external funding in addition to their regular budgets. Forty-five percent (1999: 31 %) receive support from manufacturers in the form of hard- and software for application studies. CONCLUSION: Regrettably the research situation in abdominal ultrasonography has not improved considerably during the observed time span. As already stated in 1999, the urgent need for improved research funding for what is the most widely applied image modality still remains an ongoing concern.

Gallstone prevalence and risk factors for gallstone disease in an urban population of children and adolescents.

BACKGROUND: At present only a few sonography-based studies have assessed gallstone prevalence and associated risk factors in children and adolescents in randomly selected urban population samples. The aim of the present study was to analyze the prevalence of cholecystolithiasis and associated risk factors in children and adolescents. METHODS: From a randomly selected urban population sample a total of 307 children and adolescents (157 girls, 150 boys; age 12 - 18 years, mean age 15.1 +/- 2.0 years) were studied using ultrasonography, standardized questionnaires and blood samples. RESULTS: Three adolescents (one girl, two boys), corresponding to a prevalence of 1.0 %, showed gallstones. One 14-year-old girl and one 17-year-old boy were overweight using Cole's classification. A positive family history and female gender could not be confirmed as risk factors. CONCLUSION: Obesity appears to be a risk factor in the development of gallstones in childhood and adolescence.

Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn's disease.

The purposes of this study was to provide a retrospective comparison of semiquantitatively measured bowel wall vascularity by power Doppler sonography, endoscopic-histopathological biopsy findings, and disease activity in patients with confirmed Crohn's disease. Thirty-two out of 1,332 patients with histologically confirmed Crohn's disease (18 female, 14 male; mean age 38.8 years) met the inclusion criteria: ileocolonoscopy with biopsy and power Doppler sonographic determination of bowel wall vascularity with assessment of disease activity within a period of 5 days. Sonographic determination of bowel wall vascularity was based on a semiquantitative score. Endoscopic bowel wall biopsy specimens were assessed using a self-developed inflammation score and the disease activity was calculated using Crohn's disease activity index (CDAI). A significant association (p < 0.05) was shown for results of histology and bowel wall vascularity in the terminal ileum (kappa = 0.66; sensitivity 95%; specificity 69%). There was no observed association between CDAI and histology, although there was an association between CDAI and bowel wall vascularity (sensitivity 82%). Increased bowel wall vascularity in the terminal ileum measured by power Doppler ultrasound reflects inflammatory activity in histologically examined bowel wall. Power Doppler ultrasound may be able to monitor activity changes of the bowel wall determined by pharmaceutical treatment.

Screening methods in alveolar echinococcosis: a follow-up study comparing Emc- and Emf-ELISA with Em2plus-ELISA and ultrasonography.

The purpose of the present study was to identify Echinococcus multilocularis infection in follow-up of 95 subjects initially seropostive by Emc-ELISA or Emf-ELISA antibody assays and to compare the utility of these assays with specific Em2plus-ELISA and ultrasound screening for E. multilocularis infection. At follow-up seven subjects were seropositive with both methods, while three were seropositive only with Emc-ELISA and 11 only with Emf-ELISA. All subjects were seronegative with Em2plus-ELISA. There were no manifestations of E. multilocularis infestation by ultrasonographic screening. Seropositivity on Emc-ELISA and Emf-ELISA screening tests does not appear to correlate with manifest alveolar echinococcosis identified by ultrasound. A recommendation for further follow-up of subjects found to be seropositive with Emc-ELISA and Emf-ELISA but with no sonographic evidence of disease is not justified at this time.