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

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.