title: EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study.
abstract: BACKGROUND
  Both EUS and ERCP sampling techniques may provide tissue diagnoses in suspected malignant biliary obstruction. However, there are scant data comparing these 2 methods.
  
  
  OBJECTIVE
  To compare EUS-guided FNA (EUS-FNA) and ERCP tissue sampling for the diagnosis of malignant biliary obstruction.
  
  
  METHODS
  Prospective, comparative, single-blind study.
  
  
  METHODS
  Tertiary center.
  
  
  METHODS
  Fifty-one patients undergoing same-session EUS and ERCP for the evaluation of malignant biliary obstruction over a 1-year period.
  
  
  METHODS
  EUS-FNA and ERCP tissue sampling with biliary brush cytology and intraductal forceps biopsies.
  
  
  METHODS
  Diagnostic sensitivity and accuracy of each sampling method compared with final diagnoses.
  
  
  RESULTS
  EUS-FNA was more sensitive and accurate than ERCP tissue sampling (P < .0001) in 51 patients with pancreatic cancers (n = 34), bile duct cancers (n = 14), and benign biliary strictures (n = 3). The overall sensitivity and accuracy were 94% and 94% for EUS-FNA, and 50% and 53% for ERCP sampling, respectively. EUS-FNA was superior to ERCP tissue sampling for pancreatic masses (sensitivity, 100% vs 38%; P < .0001) and seemed comparable for biliary masses (79% sensitivity for both) and indeterminate strictures (sensitivity, 80% vs 67%).
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  EUS-FNA is superior to ERCP tissue sampling in evaluating suspected malignant biliary obstruction, particularly for pancreatic masses. EUS-FNA appears similar to ERCP sampling for biliary tumors and indeterminate strictures. Given the superior performance characteristics of EUS-FNA and the higher incidence of pancreatic cancer compared with cholangiocarcinoma, EUS-FNA should be performed before ERCP in all patients with suspected malignant biliary obstruction. (
  
  
  BACKGROUND
  NCT01356030.).
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Weilert
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Bhat
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Kane
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Jaffee
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Rees
authors.initials: R
authors.lastname: Cameron
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis*; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method