Abstract
Background
Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) often are required in the evaluation and treatment of patients with pancreaticobiliary disorders. Few reports of single-session EUS-ERCP have raised questions regarding its safety and accuracy or about which procedure should be performed first.
Methods
Data from 2005 to 2009 were reviewed from a prospectively maintained EUS-ERCP database at a single tertiary care cancer center. Sensitivity and specificity of EUS and fine-needle aspiration (FNA), bile duct cannulation rate, duration of procedure, and complications were evaluated.
Results
Of the 35 patients (15 men and 20 women) studied, 28 had a final diagnosis of malignancy, and 7 had benign disorders. All the patients underwent ERCP and EUS, with FNA performed for 28 patients (80%). For 22 of the 35 patients (62.8%), EUS was the first procedure performed. The sensitivity of EUS-FNA for malignancy was 96.4%. The bile duct cannulation rate during ERCP was 97.1%. Five patients required a precut sphincterotomy for bile duct access, and one patient with chronic pancreatitis had a failed cannulation despite a EUS-guided rendezvous. A stent was successfully placed in 29 patients (96%). No major complications occurred, and no contrast leak was seen when FNA was performed before the cholangiogram. One patient had periduodenal bleeding after FNA, which was managed conservatively. The mean duration of the procedure was 83.7 min.
Conclusion
Single-session EUS-ERCP can be performed safely and with efficacy similar to that of the procedures performed separately.
Similar content being viewed by others
References
Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB (2005) Pancreatic FNA in 1,000 cases: a comparison of imaging modalities. Gastrointest Endosc 61:854–861
DeWitt J, Devereaux B, Chriswell M, McGreevy K, Howard T, Imperiale TF, Ciaccia D, Lane KA, Maglinte D, Kopecky K, LeBlanc J, McHenry L, Madura J, Aisen A, Cramer H, Cummings O, Sherman S (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141:753–763
Mansfield JC, Griffin SM, Wadehra V, Matthewson K (1997) A prospective evaluation of cytology from biliary strictures. Gut 40:671–677
Jailwala J, Fogel EL, Sherman S, Gottlieb K, Flueckiger J, Bucksot LG, Lehman GA (2000) Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc 51:383–390
Mergener K, Jowell PS, Branch MS, Baillie J (1998) Pneumoperitoneum complicating ERCP performed immediately after EUS-guided fine needle aspiration. Gastrointest Endosc 47:541–542
Di Matteo F, Shimpi L, Gabbrielli A, Martino M, Caricato M, Esposito A, De Cicco ML, Coppola R, Costamagna G (2006) Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious? Endoscopy 38:1149–1151
Tarantino I, Barresi L, Di Pisa M, Traina M (2007) Simultaneous endoscopic ultrasound fine-needle aspiration and endoscopic retrograde cholangiopancreatography: evaluation of safety. World J Gastroenterol 13:3861–3863
Polkowski M, Regula J, Tilszer A, Butruk E (2007) Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a randomized trial comparing two management strategies. Endoscopy 39:296–303
Arguedas M, Heudebert GH, Stinnett AA, Wilcox CM (2002) Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis. Am J Gastroenterol 97:898–904
Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, Canard JM, Fritsch J, Rey JF, Burtin P (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57:178–182
Karakan T, Cindoruk M, Alagozlu H, Ergun M, Dumlu S, Unal S (2009) EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a prospective randomized trial. Gastrointest Endosc 69:244–252
Ross W, Wasan S, Evans D, Wolff R, Trapani L, Staerkel G, Prindiville T, Lee J (2008) Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc 68:461–466
Shajan P, Eloubeidi M (2009) Feasibility of combined EUS-FNA and ERCP for obstructive jaundice from presumed pancreatic malignancy. Nat Clin Pract Gastroenterol Hepatol 6:132–133
Disclosures
Gil Ascunce, Afonso Ribeiro, Caio Rocha-Lima, Marcelo Larsen, Jaime Merchan, Danny Sleeman, Joe Levi, and Deborah Szabo have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ascunce, G., Ribeiro, A., Rocha-Lima, C. et al. Single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for evaluation of pancreaticobiliary disorders. Surg Endosc 24, 1447–1450 (2010). https://doi.org/10.1007/s00464-009-0798-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0798-3