2006•EndoscopyRequires access
Diagnostic yield and safety of sequential endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in pancreatobiliary disorders
Carlos Ortiz-Moyano, FJ Pellicer-Bautista, V. Leria-Yebenes, Rafael Romero-Castro, J.M. Herrerias-Gutierrez
Open publisher page 0 citations
Abstract
Aims: EUS and ERCP are complementary procedures in pancreatobiliary processes (PBD). Our aim was to evaluate the diagnostic yield and safety of both procedures performed in the same endoscopic session. Patients and methods: From October 2004 to February 2006, 39 patients were enrolled in a prospective study. Clinical indications for were jaundice (69%), abdominal pain (25%), cholestasis (2%) and pancreatic fistula (2%). In 20 (51%) patients PBD were suspected by abdominal ultrasound (US) and CT scan without diagnosis whereas 19 (48%) had a definitive diagnosis made by US and CT scan. Mean age was 62.4 years (range 25–94). 29 male and 10 female. Explorations were performed in the endoscopy room under deep sedation and monitorized by an anesthesiologist. All patients were under medical observation 24 hours after exploration. No antibiotics were administered except in one case of fever in a Klatskin's tumor. We used a lineal Pentax® echoendoscope and a Olympus® duodenoscope with a 4.2 millimeters working channel. 22-G needles (GIP-Mediglobe and Wilson-Cook) were used in all cases except in two cases of rendez-vous (19G needle). Results: EUS was first performed in 33 cases (84.61%). EUS-FNA was done in 20 cases (51.28%). Therapeutic ERCP was performed in 27 cases (70%), including 15 stents, 2 biliary drainages, 2 stone removal and 8 sphincterotomies. ERCP was avoided in 12 patients (30.7%) after EUS findings. Final diagnosis were pancreatic adenocarcinoma (11), ampullary tumor (2), papillitis (7), cholangiocarcinoma (6), chronic pancreatitis (3), pancreatic pseudocyst (3), and others (7). No major complications were recorded after 30 days. Conclusions: In our experience, EUS-ERCP is a safe combination allowing diagnosis, staging and treatment of PBD in a single endoscopic session and being EUS the most accurate diagnostic technique avoiding unnecessary ERCPs.