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• W2978002477 abstract "Introduction: Pancreatic head tumors, a common cause of obstructive jaundice, are associated with significant morbidity and mortality. Tissue diagnosis of the tumor via EUS-FNA is essential. ERCP with placement of CBD stent is considered particularly when neo-adjuvant therapy is recommended. Two major impacting factors on the procedure time are the ease of CBD cannulation and the number of FNA passes required to establish the diagnosis. Performing the EUS-FNA before the ERCP could potentially cause local trauma to the distal CBD within the pancreatic head mass leading to difficult cannulations. When ERCP with biliary stenting is performed prior to EUS-FNA, a potential stent artifact can interfere with tumor localization and staging. We conducted a retrospective study to evaluate the optimal sequence that can positively impact successful cannulation, number of FNA passes and the total procedure time. Methods: Fifty three combined EUS-FNA with ERCP procedures performed in the same session by two experienced endoscopists with formal advanced fellowship training were randomly selected for this purpose. The inclusion criteria were obstructive jaundice secondary to pancreatic head mass and presence of a virgin papilla. Patients with previous sphincterotomy, CBD stent and PTC drain placement were excluded. Cases were grouped according to the personal practices of the endoscopists. In group 1, the sequence of procedures was radial EUS→ERCP with CBD stenting→curvilinear EUS-FNA while in group 2, it was radial EUS→curvilinear EUS-FNA→ERCP with CBD stenting. Descriptive and non-parametric analysis was performed. Results: Thirty four cases were in group 1 while group 2 had 19 cases. In group 1, the average age was 69.24 years (+ 12.23, SD) with 20 women and 14 men. The average fluoroscopy time was 8.34 minutes (+5.97, SD). The average number of FNA passes was 3.18 (+1.6, SD). All the cannulations were successful. In group 2, the average age was 68.95 years (+ 12.97) with 11 women and 6 men. The mean length of fluoroscopy time was 8.32 minutes (+2.43) and number of FNA passes was 2.58 (+ 2.58). Two cannulations were unsuccessful in group 2. The results were not statistically significant due to a small sample size. Conclusion: Simultaneous ERCP with CBD stenting and EUS-FNA is associated with more successful cannulations when compared to EUS-FNA followed by ERCP. However, higher number of passes were required when ERCP was performed before the EUS-FNA." @default.
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• W2978002477 date "2015-10-01" @default.
• W2978002477 modified "2023-09-27" @default.
• W2978002477 title "Simultaneous EUS-FNA and ERCP for a Pancreaticobiliary Obstructive Mass: What Should Be the Sequence?" @default.
• W2978002477 doi "https://doi.org/10.14309/00000434-201510001-00075" @default.
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