Combined use of Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) for Evaluation of Obstructive Jaundice and Distal Biliary Strictures

Aims To assess the accuracy of EUS and ERCP combined and compared with radiologic imaging (CT, MRT/MRCP) in patients with obstructive jaundice and distal biliary strictures.

Methods Our retrospective study included all patients with painless jaundice, who received EUS with fine-needle aspiration (FNA), and ERCP with brush cytology or/and biliary duct biopsy between 01/2017-09/2020. Before the procedure, at least one radiological examination (CT, MRT/MRCP) was performed. Positive cyto-/histopathology was defined as the finding of at least atypical cells with dysplasia. Final diagnosis was established through a combination of histopathology, surgery, radiological findings, autopsy and clinical follow-up.

Results We identified 57 patients (mean age 72.1±12.1 years,57.8 % males) with painless obstructive jaundice evaluated by both EUS and ERCP. In 23/57 cases(40.3 %), both investigations were performed on the same day. Overall 44/57(77.2 %) cases presented malignancy. The final diagnosis was: pancreatic adenocarcinoma–35(61.4 %), cholangiocarcinoma–7(12.3 %), chronic pancreatitis–7(12.3 %), inflammatory benign biliary strictures-6(10.6 %), neuroendocrine pancreatic tumor–1(1.7 %), and sarcoma -1(1.7 %). EUS guided sampling was performed more often than ERCP(86.6 % vs. 49.1 %), and tended to show better accuracy (80.8 % vs.71.4 %,p=40). With the combination of EUS and ERCP 51/57 (89.4 %) cases were correctly diagnosed. The accuracy of combined use of EUS and ERCP increased with the experience of endoscopists: 73.6 % between 01/2017-12/2018 vs.97.3 % between 01/2019-10/2020,p=0.03. We did not observed sedation related adverse events in our cohort of patients, even if the both investigations were performed in the same day. In 7/57(12.2 %) of cases only EUS could detect the tumor (while CT and/or MRT were negative), while not a single case was detected with radiologic imaging (CT, MRT) but would have been missed on EUS.

Conclusions The combination of EUS and ERCP in diagnostic work-up of patients with painless obstructive jaundice is useful and more accurate to exclude malignancy in distal biliary stenosis compared to imaging with CT or MRT/MRCP.

Citation Bota S, Razpotnik M, Essler G et al. eP390 COMBINED USE OF ENDOSCOPIC ULTRASOUND (EUS) AND ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) FOR EVALUATION OF OBSTRUCTIVE JAUNDICE AND DISTAL BILIARY STRICTURES. Endoscopy 2021; 53: S223.

Publication History

Article published online:
19 March 2021