Faculty Collaboration Database

Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc 2008 Sep;68(3):461-6

Date

04/04/2008

Pubmed ID

18384788

DOI

10.1016/j.gie.2007.11.033

Scopus ID

2-s2.0-50149120981 (requires institutional sign-in at Scopus site)   70 Citations

Abstract

BACKGROUND: An EUS-guided FNA (EUS-FNA) and a therapeutic ERCP are frequently required for the evaluation of patients who were seen for an obstructing periampullary lesion.

OBJECTIVE: To determine the feasibility and outcomes of combining an EUS-FNA and a therapeutic ERCP into a single session.

DESIGN: Retrospective single-center study.

SETTING: Tertiary-referral cancer center.

PATIENTS: A total of 114 patients with a suspected malignant obstructing lesion in the pancreatic head.

INTERVENTIONS: An EUS with or without FNA plus an ERCP.

MAIN OUTCOME MEASUREMENTS: Duration, diagnostic yield, and complication rate of the combined procedures.

RESULTS: The mean (SD) total procedure time (EUS, with or without FNA plus ERCP) was 73.6 +/- 30 minutes, with a median of 66 minutes (range 25-148 minutes). In many cases, cytologic diagnosis from FNA became available during an ERCP, which obviated the need for further sampling. EUS-FNA had a sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 84.6%, 100%, 100%, 62.9%, and 87.8%, respectively. During an ERCP, endoscopic sphincterotomies were performed in 51 patients, and biliary stents were placed in 96 patients. Twelve patients (10.5%) had a complication, with 6 having postprocedural pancreatitis.

LIMITATIONS: Retrospective single-center experience.

CONCLUSIONS: Combined EUS-FNA and therapeutic ERCP is technically feasible, with a complication rate no higher than the component procedures, while efficiently providing tissue diagnosis and biliary drainage.

Author List

Ross WA, Wasan SM, Evans DB, Wolff RA, Trapani LV, Staerkel GA, Prindiville T, Lee JH

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Biliary Tract Diseases
Biopsy, Fine-Needle
Cholangiopancreatography, Endoscopic Retrograde
Cohort Studies
Diagnosis, Differential
Endosonography
Female
Humans
Immunohistochemistry
Jaundice, Obstructive
Male
Middle Aged
Pancreatic Neoplasms
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Ultrasonography, Interventional