Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

Sharma, Shyam Sundar; Ram, Seva; Maharshi, Sudhir; Shankar, Vijay; Katiyar, Prashant; Jhajharia, Ashok; Sardava, Vimal; Bhardwaj, Hemendra

doi:10.4103/2303-9027.121247

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…We have shown that in comparison with control patients, patients with opium addiction exhibit larger ampulla of Vater, a finding compatible with that reported by Sharma et al 10 However, the size of the ampulla of Vater in Sharma and colleagues’ study was greater than that reported in our study (71.9 vs 39.1 mm 2 ). This difference might, at least in part, be due to the longer duration of opium addiction in their patient population.…”

Section: Discussionsupporting

confidence: 92%

“…Although in Sharma and colleagues’ study, 10 CBD dilatation was noted in all 15 cases, PD dilation in the pancreatic body was detected in only two cases. In contradistinction, amongst our 56 cases, all patients exhibited both dilated CBDs and PDs.…”

Section: Discussionmentioning

confidence: 68%

“…Sharma et al reported EUS findings in 15 patients with opium addiction who presented with abdominal pain. 10 None of those patients had GB stones. This discrepant finding might be due, at least in part, to the small number of patients in their sample.…”

Section: Discussionmentioning

confidence: 93%

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Opium Effects on Pancreatobiliary System in Opium Abusers Evaluated by Endoscopic Ultrasonography

Sotoudehmanesh,

Ali Asgari,

Bagheri

et al. 2023

Middle East J Dig Dis

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Background: Opium use is a significant social and public health issue. There are numerous effects of opium documented as affecting the pancreatobiliary system. The aim of the study was to assess the pancreatobiliary changes in patients with opium addiction by endoscopic ultrasonography (EUS). Methods: During the study period, consecutive patients who were referred for EUS of submucosal upper gastrointestinal lesions were included. The history of opium addiction and clinical symptoms were recorded prospectively. Diameters of the common bile duct (CBD), pancreatic duct (PD), size of the ampulla of Vater, and gallbladder abnormalities were evaluated using EUS. Results: A total of 254 patients (53.1% male, mean age of 55.4±14.2 years) were studied. A history of opium addiction was present in 56 patients (22.0%). Choledocholithiasis was found in two patients (3.6%) and one control (0.5%) patient (P=0.06). Gallbladder stones were found in 13 opium-addict (23.2%) and 16 control (8.1%) patients (P=0.002). The mean diameter of the CBD, size of the ampulla of Vater (P<0.001), and PD (P=0.04) were all significantly greater in patients with opium addiction. Conclusion: Dilation of the biliary and PDs is seen more commonly in patients addicted to opium. However, the clinical implications of these findings need to be further evaluated in future studies.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 68%

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Opium Effects on Pancreatobiliary System in Opium Abusers Evaluated by Endoscopic Ultrasonography

Sotoudehmanesh,

Ali Asgari,

Bagheri

et al. 2023

Middle East J Dig Dis

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“…Other studies have shown a significant relationship between CBD diameter and opium addiction. 13 , 16 The present study found a relationship between CBD stone size and addiction where the stones of the addicted patients were significantly bigger. It mainly happens because the opium causes the bile ducts to get dilated, resulting in the stones with a larger diameter blocking the bile flow, thereby leading to the choledocholithiasis signs in the patients.…”

Section: Discussionsupporting

confidence: 49%

Addiction and the Risk of Common Bile Duct Stones: A 4-Year Retrospective Population-Based Study in Mashhad, Iran

Beheshti Namdar,

AkbariRad,

Farzaneh Far

et al. 2023

Addict Health

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Background: As a common digestive disorder, choledocholithiasis can have serious consequences, including death. Given that opioids have been shown to contribute to the spasm of Oddi’s sphincter, which results in biliary stasis in the common bile duct (CBD), it is likely that opioids can also raise the prevalence of choledocholithiasis. In this regard, this study aimed to investigate how common opium addiction was among choledocholithiasis patients in Mashhad, Iran. Methods: The current retrospective observational study was conducted on 599 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP), utilizing information gathered at the Ghaem hospital in Mashhad, Iran, between 2011 and 2015. Patient data were collected from files and records using certain criteria such as gender, opium addiction, hepatic enzymes (AST, ALT, ALP), plasma levels of total bilirubin, and direct bilirubin. The size of the CBD stones as well as the correlation between the gallbladder and CBD stones were calculated. Findings: From among 599 patients included, 345 (57.6%) were female and 254 (42.4%) were male. Moreover, 195 patients (32.2%) had opiate addictions. The size of the CBD stone was correlated with the patient’s age (r=0.17, P=0.001). The average stone measured 12.22±3.32 mm. There were notable differences in the mean size of the CBD stone (P<0.001) between addicted and non-addicted cases; specifically, the mean CBD stone size in addicted cases was 12.715.13 mm while it was 12.34.33 mm in non-addicted cases. Conclusion: This study showed patients with CBD stones have a higher rate of opium addiction compared to the general population, indicating a possible link between the two conditions.

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“…In a recent study, opium addicts, symptomatic for abdominal pain were subjected to EUS. The authors observed CBD dilatation, especially in the extra hepatic tract, in all 15 patients included and increased surface area of Vater's papilla in 12 of them, after a mean of 20 years of opium addiction [21] . Pathologic conditions are also able to induce isolated bile duct dilatations with non-specific symptoms or biochemical abnormalities.…”

Section: Causes Of Biliary Dilatationmentioning

confidence: 99%

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

Angelis¹,

Marietti²,

Bruno³

et al. 2015

WJGE

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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. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. 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 biliary disease is considered low. 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. The aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects. Core tip: Common bile duct dilatation, often without identified causes, in subjects with normal liver function tests and nonspecific abdominal symptoms, and absence of lesions on prior noninvasive imaging tests, is increasingly found in the clinical practice. Since the clinical suspicion for biliary pathology in that setting is usually low, and there are limited literature data, this condition is ignored. However, recent evidences show the existence of pathologies among these patients, often with a non-benign course. In this scenario, endoscopic

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Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

Cited by 6 publications

References 7 publications

Opium Effects on Pancreatobiliary System in Opium Abusers Evaluated by Endoscopic Ultrasonography

Opium Effects on Pancreatobiliary System in Opium Abusers Evaluated by Endoscopic Ultrasonography

Addiction and the Risk of Common Bile Duct Stones: A 4-Year Retrospective Population-Based Study in Mashhad, Iran

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

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