Combined Versus Separate Sessions of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for the Di
- PDF / 899,523 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 196 Views
ORIGINAL ARTICLE
Combined Versus Separate Sessions of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for the Diagnosis and Management of Pancreatic Ductal Adenocarcinoma with Biliary Obstruction Tugrul Purnak1 · Ihab I. El Hajj2 · Stuart Sherman3 · Evan L. Fogel3 · Lee McHenry3 · Glen Lehman3 · Mark A. Gromski3 · Mohammad Al‑Haddad3 · John DeWitt3 · James L. Watkins3 · Jeffrey J. Easler3 Received: 9 December 2019 / Accepted: 12 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background A single-procedure session combining EUS and ERCP (EUS/ERCP) for tissue diagnosis and biliary decompression for pancreatic duct adenocarcinoma (PDAC) is technically feasible. While EUS/ERCP may offer expedience and convenience over an approach of separate procedures sessions, the technical success and risk for complications of a combined approach is unclear. Aims Compare the effectiveness and safety of EUS/ERCP versus separate session approaches for PDAC. Methods Study patients (2010–2015) were identified within our ERCP database. Patients were analyzed in three groups based on approach: Group A: Single-session EUS-FNA and ERCP (EUS/ERCP), Group B: EUS-FNA followed by separate, subsequent ERCP (EUS then ERCP), and Group C: ERCP with/without separate EUS (ERCP ± EUS). Rates of technical success, number of procedures, complications, and time to initiation of PDAC therapies were compared between groups. Results Two hundred patients met study criteria. EUS/ERCP approach (Group A) had a longer index procedure duration (median 66 min, p = 0.023). No differences were observed between Group A versus sequential procedure approaches (Groups B and C) for complications (p = 0.109) and success of EUS-FNA (p = 0.711) and ERCP (p = 0.109). Subgroup analysis (> 2 months of follow-up, not referred to hospice, n = 126) was performed. No differences were observed for stent failure (p = 0.307) or need for subsequent procedures (p = 0.220). EUS/ERCP (Group A) was associated with a shorter time to initiation of PDAC therapies (mean, 25.2 vs 42.7 days, p = 0.046). Conclusions EUS/ERCP approach has comparable rates of success and complications compared to separate, sequential approaches. An EUS/ERCP approach equates to shorter time interval to initiation of PDAC therapies. Keywords ERCP · Endoscopic ultrasound · Pancreatic ductal adenocarcinoma · Obstructive jaundice
Introduction * Jeffrey J. Easler [email protected] 1
Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, 6431 Fannin, MSB1.150, Houston, TX 77030, USA
2
Division of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
3
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd., Ste 1634, Indianapolis, IN 46202, USA
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer death in the USA. The 5-year survival for PDAC is less than 7% due to late stage at
Data Loading...
