Download PDF
Endoscopy 2006; 38(11): 1149-1151
DOI: 10.1055/s-2006-944845
Case report
© Georg Thieme Verlag KG Stuttgart · New York

Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious?

F.  Di Matteo1 , L.  Shimpi1 , A.  Gabbrielli1 , M.  Martino1 , M.  Caricato2 , A.  Esposito2 , M.  L.  De Cicco3 , R.  Coppola2 , G.  Costamagna1, 4
  • 1 Department of Digestive Diseases, GI Endoscopy Unit, Università Campus Bio-Medico, Rome, Italy
  • 2 Department of Digestive Diseases, Surgery Unit, Università Campus Bio-Medico, Rome, Italy
  • 3 Radiology Unit DEA, “Umberto I” Policlinic of Rome, Italy
  • 4 Department of Surgical Endoscopy, Catholic University, Rome, Italy
Further Information

Publication History

Submitted 18 May 2006

Accepted after revision 12 August 2006

Publication Date:
17 November 2006 (online)

Also available at
    Permissions and Reprints

Patients who are undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for suspected pancreatic tumors frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for palliation of their symptoms. Performing EUS-FNA and ERCP in tandem may be cost-effective and may reduce procedure time, but the potential risks associated with this approach have not been clearly defined in the literature. We report two patients who underwent same-day therapeutic ERCP after transduodenal EUS-FNA for pancreatic tumors. Endoscopic biliary manipulation during ERCP aggravated an inadvertent and subclinical needle puncture injury to the bile duct sustained during the preceding EUS-FNA. This resulted in leakage of bile into the retroperitoneal space, and both patients required laparotomy and surgical drainage. Additional clinical evidence is needed to clarify these issues and to determine whether it would be prudent to perform therapeutic ERCP prior to diagnostic transduodenal EUS-FNA when these two procedures are planned as sequential or same-day procedures.

References

  • 1 Erickson R. EUS-guided FNA.  Gastrointest Endosc. 2004;  60 267-279
    CrossrefPubMedSearch in Google Scholar
  • 2 Raut C P, Grau A M, Staerkel G A. et al . Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer.  J Gastrointest Surg. 2003;  7 118-128
    CrossrefPubMedSearch in Google Scholar
  • 3 Mergener K, Jowell P S, Branch M S. et al . Pneumoperitoneum complicating ERCP performed immediately after EUS-guided fine needle aspiration.  Gastrointest Endosc. 1998;  47 541-542
    CrossrefPubMedSearch in Google Scholar
  • 4 Bhutani M S, Hawes R H, Baron P L. et al . Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions.  Endoscopy. 1997;  29 854-858
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Lee L S, Saltzman J R, Bounds B C. et al . EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors.  Clin Gastroenterol Hepatol. 2005;  3 231-236
    CrossrefPubMedSearch in Google Scholar
  • 6 Erickson R A, Garza A A. EUS with EUS-guided fine needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice.  Gastrointest Endosc. 2001;  53 475-484
    CrossrefPubMedSearch in Google Scholar
  • 7 Rollhauser C, Kim C Y, Bandres D. et al . Feasibility of same-day endoscopic ultrasound (EUS) and ERCP [abstract].  Gastrointest Endosc. 1997;  45 AB178
    PubMedSearch in Google Scholar

F. Di Matteo, M. D.

Department of Digestive Diseases

GI Endoscopy Unit · Università Campus Bio-Medico · Via Emilio Longoni, 89 · Rome 00155 · Italy

Fax: +39-06-22541520

Email: f.dimatteo@unicampus.it