BACKGROUND: Techniques to confirm suspected pancreaticobiliary (PB) malignancy when index sampling is non-diagnostic include cholangiopancreatoscopy (CP) and endoscopic ultrasound (EUS). However, comparative data are lacking. AIM: The purpose of this study was to compare the yield of EUS and CP for the diagnosis of PB pathology. METHODS: Consecutive patients with indeterminate PB pathology who underwent both CP and EUS within 3 months of each other were retrospectively identified. For CP, tissue sampling included biopsy under direct inspection (cholangioscopy-directed biopsy), biopsy following CP with fluoroscopic guidance (cholangioscopy-assisted biopsy), or brush cytology. For EUS-FNA, lesions included ductal strictures or hypoechoic masses. A comparison of operating characteristics between CP and EUS utilizing tissue confirmation or 12-month clinical course consistent with either benign or malignant disease was performed. RESULTS: Between February 2000 and June 2007, 66 (33 males, 33 females, median age 64.5) patients with indeterminate PB pathology who had undergone both CP and EUS within 3 months of each other were included. Lesions amenable to sampling were noted in 59 CP and 50 EUS patients. On follow-up, 39 patients had neoplasia and 27 were benign. The sensitivity/specificity for the diagnosis of neoplasia for CP and EUS was 48.7/96.3 % and 33.3/96.3 %, respectively (comparison of sensitivities, P = 0.183). The combined (CP and EUS) sensitivity/specificity was 66.7/96.3 % (P = 0.0064 and P = 0.0001 comparing combined sensitivity vs. sensitivity of either CP alone or EUS alone, respectively). CONCLUSIONS: In patients who undergo both EUS and CP for indeterminate PB pathology, the combined yield of EUS and CP to detect neoplasia appears to be higher than either examination alone.
BACKGROUND: Techniques to confirm suspected pancreaticobiliary (PB) malignancy when index sampling is non-diagnostic include cholangiopancreatoscopy (CP) and endoscopic ultrasound (EUS). However, comparative data are lacking. AIM: The purpose of this study was to compare the yield of EUS and CP for the diagnosis of PB pathology. METHODS: Consecutive patients with indeterminate PB pathology who underwent both CP and EUS within 3 months of each other were retrospectively identified. For CP, tissue sampling included biopsy under direct inspection (cholangioscopy-directed biopsy), biopsy following CP with fluoroscopic guidance (cholangioscopy-assisted biopsy), or brush cytology. For EUS-FNA, lesions included ductal strictures or hypoechoic masses. A comparison of operating characteristics between CP and EUS utilizing tissue confirmation or 12-month clinical course consistent with either benign or malignant disease was performed. RESULTS: Between February 2000 and June 2007, 66 (33 males, 33 females, median age 64.5) patients with indeterminate PB pathology who had undergone both CP and EUS within 3 months of each other were included. Lesions amenable to sampling were noted in 59 CP and 50 EUS patients. On follow-up, 39 patients had neoplasia and 27 were benign. The sensitivity/specificity for the diagnosis of neoplasia for CP and EUS was 48.7/96.3 % and 33.3/96.3 %, respectively (comparison of sensitivities, P = 0.183). The combined (CP and EUS) sensitivity/specificity was 66.7/96.3 % (P = 0.0064 and P = 0.0001 comparing combined sensitivity vs. sensitivity of either CP alone or EUS alone, respectively). CONCLUSIONS: In patients who undergo both EUS and CP for indeterminate PB pathology, the combined yield of EUS and CP to detect neoplasia appears to be higher than either examination alone.
Authors: Raj J Shah; Douglas G Adler; Jason D Conway; David L Diehl; Francis A Farraye; Sergey V Kantsevoy; Richard Kwon; Petar Mamula; Sarah Rodriguez; Louis Michel Wong Kee Song; William M Tierney Journal: Gastrointest Endosc Date: 2008-06-05 Impact factor: 9.427
Authors: J Jailwala; E L Fogel; S Sherman; K Gottlieb; J Flueckiger; L G Bucksot; G A Lehman Journal: Gastrointest Endosc Date: 2000-04 Impact factor: 9.427
Authors: John DeWitt; Vijay Laxmi Misra; Julia Kim Leblanc; Lee McHenry; Stuart Sherman Journal: Gastrointest Endosc Date: 2006-09 Impact factor: 9.427
Authors: Thomas Rösch; Alexander Meining; Silke Frühmorgen; Christian Zillinger; Volker Schusdziarra; Karin Hellerhoff; Meinhard Classen; Hermann Helmberger Journal: Gastrointest Endosc Date: 2002-06 Impact factor: 9.427
Authors: A Fritscher-Ravens; D C Broering; W T Knoefel; X Rogiers; P Swain; F Thonke; C Bobrowski; T Topalidis; N Soehendra Journal: Am J Gastroenterol Date: 2004-01 Impact factor: 10.864
Authors: Thomas Rösch; Kim Hofrichter; Eckart Frimberger; Alexander Meining; Peter Born; Norbert Weigert; Hans-Dieter Allescher; Meinhard Classen; Marius Barbur; Ulrich Schenck; Martin Werner Journal: Gastrointest Endosc Date: 2004-09 Impact factor: 9.427