الفهرس 
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Abstract
In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. (Angelis et al., 2015)
However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic workup. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having the biliary disease is considered low. (Angelis et al., 2015)
In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. (Angelis et al., 2015)
The aim of this study is to compare between the accuracy of endoscopic ultrasound and endoscopic retrograde cholangiography as a diagnostic tool for patients with dilated common bile duct in whom abdominal ultrasonography could not demonstrate the cause of dilatation.
This study was conducted on eighty (80) patients which had been carried out during the period between May 2018 and October 2018, the study was performed as a retrospective analysis of prospectively collected data between January 2017 and October 2018, of patients had being undergone EUS and ERCP to compare between the accuracy of both as a diagnostic tool in whom TUS couldn’t demonstrate the cause of CBD dilatation, the study was performed as a retrospective analysis of prospectively collected data at TBRI (Theodor Bilharz Research Institute) after approval was obtained from the ethics and indications committee of TBRI. The study protocol was approved by the medical ethics committee of Ain Shams University and TBRI.
All patients with obstructive jaundice and TUS showed CBD dilatation with internal diameter ≥ 7 mm underwent EUS and ERCP to compare between the accuracy of both as a diagnostic tool in whom TUS couldn’t demonstrate the cause of CBD dilatation.
This study showed that the mean age was 52 and most patients were males (53.75%)
This study showed that as regards the present history characteristics among study subjects were as follows in which upper abdominal pain (80 cases =100%), Jaundice was present in 72 cases (90%), weight loss 37 cases (46.25%)
There was significant relation between the detectable CBD pathology by EUS in abnormal alkaline Phosphatase groups was as follows (malignant stricture 39, stones in 22, and benign CBD stricture in 8, and Prominent CBD with no obvious obstruction in 2 patients, respectively)
Also, there was significant relation between the detectable CBD pathology by ERCP in abnormal alkaline Phosphatase groups in the current study was as follows (malignant stricture 24 patients, indeterminate stricture in 24 patients, stones in 20 patients, and benign CBD stricture in 1 patient, respectively)
This study revealed that no difference between the diagnostic capability of CT/MRCP in comparison to EUS and ERCP in detecting pathological causes of CBD dilatation either stone or malignant causes confirmed by FNA - EUS sample from 44 patients out of 80 patients.
This study revealed that the EUS was statistically significantly more valuable in diagnosing stone, stricture, benign, malignant, prominent CBD no obstruction than ERCP, P Value= <0.001. New findings with EUS in comparison to ERCP were as follows, 2 cases out of 4 cases of prominent CBD with no obstruction diagnosed as microlithiasis and all cases with indeterminate stricture were diagnosed as 2 cases with microlithiasis, 8 cases with benign stricture and 16 cases diagnosed as a malignant stricture.