Introduction Unexplained common bile duct (CBD) dilatation is a frequent and often challenging clinical finding in gastroenterology practice. Although cross-sectional imaging may fail to identify a cause, endoscopic ultrasound (EUS) can detect clinically significant biliary and periampullary pathology that may require intervention.
Introduction
Unexplained common bile duct (CBD) dilatation is a frequent and often challenging clinical finding in gastroenterology practice. Although cross-sectional imaging may fail to identify a cause, endoscopic ultrasound (EUS) can detect clinically significant biliary and periampullary pathology that may require intervention. The challenge lies in identifying which patients are most likely to benefit from EUS while avoiding unnecessary procedures in low-risk individuals.
Problem Statement
Not all patients with isolated CBD dilatation harbor clinically meaningful pathology, yet routine EUS for all such patients is resource-intensive and may not be justified. A practical and validated clinical tool is needed to identify patients with a high likelihood of actionable findings and better guide EUS utilization in this increasingly common diagnostic scenario.
Summary
This study presents the development and prospective validation of the GCAL score, a practical risk stratification tool designed to identify patients with unexplained CBD dilatation who are most likely to benefit from EUS. The score incorporates five readily available clinical variables—gallbladder status, CBD diameter, age and liver function abnormalities—to predict the likelihood of actionable findings requiring endoscopic or surgical intervention. In both derivation and validation cohorts, EUS identified actionable pathology in approximately half of patients, underscoring its diagnostic value in this setting. The GCAL score demonstrated strong predictive performance and reliably distinguished patients at higher risk of clinically significant findings from those less likely to benefit from further invasive evaluation. Importantly, the model performed particularly well in prospective validation, supporting its clinical applicability in routine practice. These findings provide a simple and clinically relevant framework for triaging EUS in patients with unexplained bile duct dilatation and may help optimize procedural selection, improve diagnostic efficiency and reduce unnecessary investigations.
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