Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy

William A. Ross, Sanjeev M. Wasan, Douglas B. Evans, Robert A. Wolff, Leonard V. Trapani, Gregg A. Staerkel, Thomas P Prindiville, Jeffrey H. Lee

Research output: Contribution to journalArticle

56 Scopus citations

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. Design: Retrospective single-center study. Setting: Tertiary-referral cancer center. Patients: A total of 114 patients with a suspected malignant obstructing lesion in the pancreatic head. Interventions: An EUS with or without FNA plus an ERCP. Main Outcome Measurements: 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. Limitations: 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.

Original languageEnglish (US)
Pages (from-to)461-466
Number of pages6
JournalGastrointestinal Endoscopy
Volume68
Issue number3
DOIs
StatePublished - Sep 2008
Externally publishedYes

    Fingerprint

ASJC Scopus subject areas

  • Gastroenterology

Cite this