title: Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy.
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.
  
  
  METHODS
  Retrospective single-center study.
  
  
  METHODS
  Tertiary-referral cancer center.
  
  
  METHODS
  A total of 114 patients with a suspected malignant obstructing lesion in the pancreatic head.
  
  
  METHODS
  An EUS with or without FNA plus an ERCP.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Gastroenterology, Hepatology and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Sanjeev M
authors.initials: SM
authors.lastname: Wasan
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Leonard V
authors.initials: LV
authors.lastname: Trapani
authors.forename: Gregg A
authors.initials: GA
authors.lastname: Staerkel
authors.forename: Thomas
authors.initials: T
authors.lastname: Prindiville
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D044963:Biopsy, Fine-Needle / Q000295:instrumentation* / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods