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Endoscopic ultrasound in suspected biliary obstruction influences ERCP burden in real clinical practice

A study in this month's issue of the European Journal of Gastroenterology & Hepatology reports on the diagnostic accuracy of endoscopic ultrasound in suspected biliary obstruction and its impact on ERCP burden in real clinical practice.

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Performing endoscopic ultrasound before endoscopic retrograde cholangiopancreatography (ERCP) has been described to be useful in cases of suspected biliary obstruction where endoscopic ultrasound can triage patients for endoscopic retrograde cholangiopancreatography.

Dr Zaheer Abdula and colleagues determined the diagnostic accuracy of endoscopic ultrasound and its impact on endoscopic retrograde cholangiopancreatography burden in real clinical practice.

The research team evaluated the safety and efficacy of endoscopic ultrasound+endoscopic retrograde cholangiopancreatography in a single endoscopic session.

The team evaluated 418 consecutive patients with suspected but unexplained biliary obstruction referred for endoscopic ultrasound before possible endoscopic retrograde cholangiopancreatography.

The research team team determined the diagnostic accuracy of endoscopic ultrasound and its value in predicting the need for endoscopic retrograde cholangiopancreatography.

Endoscopic ultrasound established whether pancreaticobiliary disorder was present, and whether therapeutic endoscopic retrograde cholangiopancreatography was required.

Endoscopic ultrasound showed pathology in 42% who had a nondilated biliary system
European Journal of Gastroenterology & Hepatology

These decisions were matched with endoscopic retrograde cholangiopancreatography findings, histology, clinical course, and follow-up.

Where endoscopic retrograde cholangiopancreatography was indicated, it was performed in the same endoscopic session.

Endoscopic ultrasound was performed in 412 out of 418 patients, and endoscopic retrograde cholangiopancreatography was considered necessary in 64%.

The research team noted that the single-session endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography was safe and effective.

The diagnostic accuracy of endoscopic ultrasound included 99% in choledocholithiasis, 90% with malignant strictures, and 92% with benign strictures.

The research team reported that endoscopic ultrasound showed pathology in 42% of patients who had a nondilated biliary system at initial investigations.

When endoscopic ultrasound indicated a normal common bile duct, this had a 100% positive predictive value for non-necessity for endoscopic retrograde cholangiopancreatography.

The median overall follow-up period was 12 months.

Dr Abdula's team commented, "Endoscopic ultrasound demonstrated high diagnostic accuracy in this mixed group of pancreaticobiliary disorder."

"This accurately guided endoscopic retrograde cholangiopancreatography need and avoided unnecessary endoscopic retrograde cholangiopancreatography in 36%."

"endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the same endoscopic session for the evaluation and management of PBD is technically feasible, with safety and efficacy profiles equivalent to that of each procedure performed independently in different sessions."

Eur J of Gastroenterol & Hepatology: 2013: (25)7 :850-857
21 June 2013

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