Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology

Background: Pancreatobiliarydiseases (PBD) comprises diseases of both biliary system and pancreas and their diagnosis depends on appropriate clinical evaluation and investigations including imaging modalities like transabdominal ultrasound (TAUS), Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT); Endoscopic ultrasound(EUS) have been found to be more sensitive than other imaging modality for detecting PBD, and less invasive than endoscopic retrograde cholangiopancreatography (ERCP). Aim of study: To compare the sensitivity and specificity of EUS with other imaging studies like ERCP, TAUS, CT scan, and MRCP/MRI for diagnosing PBD. Patients & Methods: This study conducted in Kurdistan Centre for Gastroenterology and Hepatology (KCGH) from December 2013 through December 2014, after approval of institutional board ethical committee and taking written informed consents from all patients. A total number of 100 patients were enrolled in the study. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EUS, MRCP, and TAUS for PBD (benign & malignant). ERCP was used as a reference standard for comparison. Results: 60% were females and 40% were males; the main presenting symptoms were combined abdominal pain and obstructive jaundice. The sensitivity, specificity, PPV, NPV, and accuracy of EUS for detecting benign biliary diseases like (bile duct stone and its complications) were 96.1%, 65.2%, 86%, 83.3%, and 89%, respectively; and for detecting pancreatobiliary tumors (PBT) were 84.6%, 97.7%, 84.6%, 97.7%, and 96%, respectively. The sensitivity of TAUS, MRCP for diagnosing biliary diseases were 58%, and 60%, respectively; and their sensitivity for detecting PBT were 37.5%, and 50%, respectively. The comparison between CT scan and ERCP was not feasible statistically. Conclusion: EUS has a higher sensitivity in comparison to other imaging modalities in detecting PBD; we can depend on it in selecting patients for therapeutic ERCP, in order to avoid unnecessary ERCP and its complications. The sensitivity and specificity of EUS in KCGH is comparable to other studies elsewhere.