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

BackgroundAn 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.ObjectiveTo determine the feasibility and outcomes of combining an EUS-FNA and a therapeutic ERCP into a single session.DesignRetrospective single-center study.SettingTertiary-referral cancer center.PatientsA total of 114 patients with a suspected malignant obstructing lesion in the pancreatic head.InterventionsAn EUS with or without FNA plus an ERCP.Main Outcome MeasurementsDuration, diagnostic yield, and complication rate of the combined procedures.ResultsThe 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.LimitationsRetrospective single-center experience.ConclusionsCombined 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.