Impact of endoscopic ultrasound on the need for ERCP in a referral center population

Background: Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are useful techniques in the evaluation of patients (pts) with biliary and pancreatic diseases. Pts undergoing EUS are commonly undergoing ERCP as well. The utility of performing both procedures has not been studied systematically. We review an 11 month experience of performing sequential EUS/ERCP on pts referred to a tertiary care center. Methods: Pts undergoing same-day EUS and ERCP between 1/97 and 11/97 were identified from a computerized database. Clinic files, endoscopic records, and radiographs were reviewed. Results: Thirty-eight pts were identified (20 females/18 males; age 26-82, mean 53). EUS preceeded ERCP in 27/38 pts and followed ERCP in the remaining 11 pts. Indications for EUS/ERCP and diagnoses made on EUS (EUS Dx) are shown below. The number of cases where ERCP added significant diagnostic information (ERCP/addDx) is indicated. ERCP/Tx denotes the number of pts requiring therapeutic interventions during ERCP. Indication (n) EUS Dx ERCP/addDx ERCP/Tx pancreatic mass (18) normal 8/18 1/81 0/8 (suspected or proven) mass 10/182 0/10 7/103 pancreatitis (8) c/w pancreatitis 8/8 0/8 4/84 pain (8) normal 5/8 1/55 1/55 c/w pancreatitis 3/8 1/36 1/36 ampullary tumor (3) amp, tumor 3/3 0/3 3/3 p.insufficiency (1) normal 1/1 0/1 0/1 1 Pancreatic juice collection revealed adeno-ca in a pt with PD stricture on ERCP and normal EUS (except for small lymph node with negative FNA). 2 FNA was positive for malignancy in 4/10 pts. 3 Stenting of CBD (6) or PD (1). 4 PD sphx (2), PD stenting (1), CBD sphx (1). 5 1 of 2 biliary manometries was abnormal; CBD sphx. 6 One pancreatic manometry was abnormal; PD sphx. Conclusions: 1. ERCP performed in addition to EUS rarely provides additional diagnostic information in pts with the above indications (in only 3/38 pts in this series). 2. The EUS diagnosis of a pancreatic mass or pancreatitis does not always obviate the need for ERCP, as therapeutic interventions are often needed (16/38 pts required therapeutic ERCP in our series). 3. Prospective studies are needed to further define who will benefit most from sequential EUS/ERCP.

Duke Scholars

Author Paul Simon Jowell Medicine, Gastroenterology

Author Rendon C. Nelson Radiology

Author Malcolm Stanley Branch Medicine, Gastroenterology