JOURNAL ARTICLE

Same-session endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography-based tissue sampling in suspected malignant biliary obstruction: A multi-center experience

Jung Hyun Jo, Chang Min Cho, Jae Hyuck Jun, Moon Jae Chung, Tae Hyeon Kim, Dong Wan Seo, Jaihwan Kim, Do Hyun Park
Journal of Gastroenterology and Hepatology 2018 October 30
30378169

Background and Aims Few studies compared endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) with endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling in terms of diagnostic accuracy in suspected malignant biliary obstruction. We evaluated and compared the diagnostic performance of EUS-FNA and ERCP-based tissue sampling.

METHODS: This multicenter study included 263 patients with suspected malignant biliary obstruction who underwent same-session EUS and ERCP between 2012 and 2016.

RESULTS: Malignancies were confirmed in 239 patients (90.9%), and benign in 24 patients (9.1%). Overall diagnostic sensitivity and accuracy were 73.6% and 76.1% for EUS-FNA, 56.5% and 60.5% for ERCP, and 85.8% and 87.1% for EUS/ERCP combination. EUS-FNA showed higher overall performances compared to ERCP (p<0.001), whereas EUS/ERCP combination was superior to EUS-FNA alone (p-value<0.001). EUS-FNA showed higher sensitivity and accuracy compared to ERCP for pancreatic masses (n=187, both p-values<0.001), but not for biliary lesions (n=76, both p-values=0.847). Sensitivity and accuracy of EUS/ERCP combination were superior to those of EUS-FNA for both pancreatic and biliary lesions (both p-values<0.001). For patients with large mass (≥4cm), there was no significant differences between ERCP/EUS combination and EUS-FNA (p-value=0.31).

CONCLUSIONS: Same-session EUS-FNA and ERCP combination was superior to EUS-FNA for both pancreatic masses and biliary lesions. Same-session EUS/ERCP combination can be considered a proper diagnostic method for suspected malignant biliary obstruction regardless of the origin of lesions. On the other hand, EUS-FNA alone was sufficient for diagnosis compared to EUS/ERCP combination in cases with large mass. Strategic diagnostic approach, according to clinical features of individual patient, is required.

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