title: Endoscopic ultrasonography in tandem with endoscopic retrograde cholangiopancreatography in the management of suspected distal obstructive jaundice.
abstract: OBJECTIVE
  To examine the benefits and feasibility of endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in tandem for distal obstructive jaundice.
  
  
  METHODS
  From September 2007 to August 2012, patients with suspected distal obstructive jaundice were randomized to single-session EUS-ERCP (group A), EUS, and ERCP in different sessions (group B), and an ERCP-only procedure (group C). Data were prospectively collected on the following parameters: ERCP-avoided, duration of procedure, the dose of propofol, complications, and diagnostic yield.
  
  
  RESULTS
  A total of 180 patients were divided randomly into 60 patients in group A, 60 in group B, and 60 in group C. A total of four therapeutic ERCP were canceled after EUS. The ERCP procedural time in group A was shorter, although not significantly different from that in group B (group A vs. group B: 41.24±7.57 vs. 43.38±6.57 min; P>0.05), but both were significantly less than that in group C (group C: 49.12±7.46 min; P<0.05). The total procedural time did not differ significantly between group A and group B (70.05±15.35 vs. 73.70±15.12 min; P>0.05), nor were there significant differences in the dose of propofol between them (group A vs. group B: 357.11±115.86 vs. 369.55±133.86 mg; P>0.05). In all, 22 anesthetic complications and 21 endoscopic complications occurred without significant differences among the three groups (P>0.05).
  
  
  CONCLUSIONS
  As a triaging or a screening tool, diagnostic EUS gives added benefit to therapeutic ERCP. EUS and ERCP in a tandem approach are safe and feasible in patients with suspected distal obstructive jaundice.
authors.affiliation: Department of Gastroenterology, Weihai Municipal Hospital, Binzhou Medical University, Weihai 264200, Shandong Province, China.
authors.forename: Yan-Liu
authors.initials: YL
authors.lastname: Chu
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Wang
authors.forename: Xiao-Zhong
authors.initials: XZ
authors.lastname: Gao
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Qiao
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Song-Yang
authors.initials: SY
authors.lastname: Yu
authors.forename: Juan
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D019160:Endosonography / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol