Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy.
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.
Ross
William A
WA
Departments of Gastroenterology, Hepatology and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Wasan
Sanjeev M
SM
Evans
Douglas B
DB
Wolff
Robert A
RA
Trapani
Leonard V
LV
Staerkel
Gregg A
GA
Prindiville
Thomas
T
Lee
Jeffrey H
JH
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