Downloads
Abstract
Objectives: To describe the imaging characteristics of endoscopic ultrasound on patients with pancreatic biliary obstruction and assess the benefits of EUS before performing ERCP.
Methods: This is a cross sectional study on 86 patients diagnosed with suspected pancreatic biliary obstruction and had ERCP indications, who underwent prior endoscopic ultrasound at Hue Central Hospital from February 2022 to February 2023.
Results: Study on 86 patients, male (45.3%) and female (54.7%), age group > 60 accounted for most of the patients at 62.8%. Recorded on EUS: the majority of pancreatic biliary obstruction are due to CBD stones, accounting for 48.8%. Observing the entire CBD by EUS was done on 97,7% of the cases. Most of the images of distal CBD stricture due to tumor compression are truncated form, accounting for 48% of the cases. Most of the CBD stones, 40.5%, are larger than 10mm. Head pancreatic duct stones accounted for 80% of cases, mobile pancreatic stones accounted for 80%, the pancreatic stone size > 5mm accounts for 40%. The majority of tumors at T3 stage accounted for 56% of the cases. Treatment results: After EUS, 26.7% of patients did not need ERCP. Bile duct stents were placed on 36% of the cases post EUS. ERCP complexity level 2 accounted for 53.9%, level 3 accounted for 31,7% and level 4 accounted for 1.6% of the cases. The overall success rate of ERCP was 93.7%.
Conclusion: Performing EUS before ERCP is very important to clarify the causes for ERCP and avoid complications of ERCP. The benefits of EUS before ERCP are to improve the endoscopists’ confidence, predict complex situations so they can have appropriate treatment attitudes and help them prepare neccesary accessories to do ERCP that lead to susccessful patients’outcomes.
References
Chen C-H, Yang C-C, Yeh Y-H, Yang T, Chung T-C.
Endosonography for suspected obstructive jaundice with
no definite pathology on ultrasonography. Journal of the
Formosan Medical Association. 2015; 114(9): 820-828.
Girawan D, Agustanti N, Muhammad Y, Nugraha E,
Bestari B. Role of Radial Endoscopic - ultrasound
(EUS) to Establish Diagnosis of Undetermined Causes
of Obstructive Jaundice: A Case Series. The Indonesian
Journal of Gastroenterology, Hepatology, and Digestive
Endoscopy. 2020; 20.
Yandrapu H, Elhanafi S, Chowdhury F, Liu J, Onate EJ,
Dwivedi A, et al. Impact of introduction of endoscopic
ultrasound on volume, success, and complexity of
endoscopic retrograde cholangiopancreatography in a
tertiary referral center. Endosc Ultrasound. 2017; 6(4):
-256.
Moutinho - Ribeiro P, Peixoto A, Macedo G. Endoscopic
Retrograde Cholangiopancreatography and Endoscopic
Ultrasound: To Be One Traveler in Converging Roads. GE
Port J Gastroenterol. 2018; 25(3): 138-145.
Hollerbach S. EUS and ERCP: brothers in arms.
Gastrointestinal Endoscopy. 2008; 68(3): 467-469.
Kim J. Training in Endoscopy: Endoscopic Retrograde
Cholangiopancreatography. Clin Endosc. 2017; 50(4):
-339.
Frenz MB, Wehrmann T. EUS and ERCP combined:
together we are strong? Gastrointest Endosc. 2006; 63(3):
-5.
Zaheer A, Anwar MM, Donohoe C, O’Keeffe S, Mushtaq
H, Kelleher B, et al. The diagnostic accuracy of endoscopic
ultrasound in suspected biliary obstruction and its impact
on endoscopic retrograde cholangiopancreatography
burden in real clinical practice: a consecutive analysis. Eur
J Gastroenterol Hepatol. 2013; 25(7): 850-7.
Hamoudi W, Endoscopic Retrograde Cholangiopancreatography
(ERCP) Textbook of Hepatogastroenterology, Part II:
Gastroenterology. 2017. p. 157-178.
Fung BM, Pitea TC, Tabibian JH. Difficult Biliary Cannulation
in Endoscopic Retrograde Cholangiopancreatography: An
Overview of Advanced Techniques. Eur Med J Hepatol.
; 9(1): 73-82.
Leszczyszyn J. Choledocholithiasis diagnostics -
endoscopic ultrasound or endoscopic retrograde
cholangiopancreatography? J Ultrason. 2014; 14(57):
-9.
D I, Fleming.M.D, AJCC Cancer Staging Manual. Seventh
Edition ed. 2010.
Trikudanathan G, Navaneethan U, Parsi MA. Endoscopic
management of difficult common bile duct stones. World J
Gastroenterol. 2013; 19(2): 165-73.
Heo JH, Kang DH, Jung HJ, Kwon DS, An JK, Kim BS, et al.
Endoscopic sphincterotomy plus large - balloon dilation versus
endoscopic sphincterotomy for removal of bile-duct stones.
Gastrointest Endosc. 2007; 66(4): 720-6; quiz 768, 771.
| Published | 29-12-2024 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 89 (2023) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.89.9 | |
| Keywords | Siêu âm nội soi và nội soi mật tụy ngược dòng Endoscopic ultrasound, Endoscopic retrograde cholangiopancreatography |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Journal of Clinical Medicine Hue Central Hospital