Combined Versus Separate Sessions of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for the Diagnosis and Management of Pancreatic Ductal Adenocarcinoma with Biliary Obstruction.
Dig Dis Sci
; 66(8): 2786-2794, 2021 08.
Article
em En
| MEDLINE
| ID: mdl-32852695
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 onapproach:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Pancreáticas
/
Adenocarcinoma
/
Colestase
/
Colangiopancreatografia Retrógrada Endoscópica
/
Endossonografia
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
Dig Dis Sci
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Estados Unidos