Skip to main content
SpringerLink
Log in

The Role of ERCP in Diagnosing Pancreatic Masses

  • Chapter
Pancreatic Masses

  • 1107 Accesses

Abstract

With the advent of endoscopic ultrasound (EUS), there has been a steady decrease in diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic malignancies. Though ERCP provides extremely accurate delineation of the pancreatobiliary system, EUS-guided fine-needle aspiration (FNA) has a diagnostic accuracy that can reach 90 % and has been shown to reduce overall costs given ERCP-related complications such as pancreatitis and cholangitis (Mesenas, Ann Acad Med Singapore 35:89–95, 2013). In contrast to EUS, which visualizes the pancreatic parenchyma, ERCP serves an important role in the detection of hepatobiliary and pancreatic ductal dilation. Given that pancreaticobiliary malignancies often present as biliary strictures, biliary brush cytology via ERCP is an established diagnostic technique in further investigating these strictures (Parsi, Deepinder, Lopez, et al. Pancreas 40(1):52–4, 2011). Pancreatic masses can cause obstructive jaundice; ERCP has both diagnostic and therapeutic roles in patients with obstructive jaundice (Khurram, Durrani, Hasan, et al. J Coll Physicians Surg Pak 13(6):325–8, 2003). Additionally, ERCP is indicated in obtaining tissue material for diagnosis in patients with atypical pancreatic head masses and to differentiate pancreatic cancer from chronic pancreatitis (Licender, Vrcic, Sadagic, et al. Med Arh 56(1 Suppl 1):25–8, 2002).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mesenas SJ. Does the advent of endoscopic ultrasound (EUS) sound the death knell for endoscopic retrograde cholangiopancreatography (ERCP)? Ann Acad Med Singapore. 2006;35:89–95.

    PubMed  Google Scholar 

  2. Parsi MA, Deepinder F, Lopez R, et al. Factors affecting the yield of brush cytology for the diagnosis of pancreatic and biliary cancers. Pancreas. 2011;40(1):52–4.

    Article  PubMed  Google Scholar 

  3. Khurram M, Durrani AA, Hasan Z, et al. Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice. J Coll Physicians Surg Pak. 2003;13(6):325–8.

    PubMed  Google Scholar 

  4. Licender L, Vrcic D, Sadagic E, et al. Magnetic resonance cholangiopancreatography (MRCP): correlation with diagnosis using ERCP. Med Arh. 2002;56(1 Suppl 1):25–8.

    Google Scholar 

  5. Nakamura T, Masuda K, Harada S, et al. Pancreatic cancer: slow progression in the early stages. Int J Surg Case Rep. 2013;4(8):693–6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Tanaka K, Kida M. Role of endoscopy in screening of early pancreatic cancer and bile duct cancer. Dig Endosc. 2009;21 Suppl 1:S97–100.

    Article  PubMed  Google Scholar 

  7. Erickson RA. Editorial ERCP and pancreatic cancer. Ann Surg Oncol. 2004;11(6):555–7.

    Article  PubMed  Google Scholar 

  8. Glasbrenner B, Schwarz M, Pauls S, et al. Prospective comparison of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the preoperative assessment of masses in the pancreatic head. Dig Surg. 2000;17(5):468–74.

    Article  CAS  PubMed  Google Scholar 

  9. Chen VK, Arguedas MR, Kilgore ML. A cost-minimization analysis of alternative strategies in diagnosing pancreatic cancer. Am J Gastroenterol. 2004;99:2223–34.

    Article  PubMed  Google Scholar 

  10. Jaiwala J, Fogel EL, Sherman S, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc. 2000;51(4 Pt 1):383–90.

    Article  Google Scholar 

  11. Miller BA, Kolonel LN, Berstein L, et al. Racial/ethnic patterns of cancer in the United States 1988–1992. Bethesda: National Cancer Institute; 1996.

    Google Scholar 

  12. Gloor B, Todd KE, Reber HA. Diagnostic workup of patients with suspected pancreatic carcinoma: the University of California–Los Angeles approach. Cancer. 1997;79(9):1780–6.

    Article  CAS  PubMed  Google Scholar 

  13. Oterdoom LH, Van Weyenberg SJ, De Boer NK. Double-duct sign: do not forget the gallstones. J Gastrointestin Liver Dis. 2013;22(4):447–50.

    PubMed  Google Scholar 

  14. Miura F, Takada T, Amano H, et al. Diagnosis of pancreatic cancer. HPB (Oxford). 2006;8(5):337–42.

    Article  Google Scholar 

  15. Spinell P, Schiavo M, Schicchi AA. Endoscopy in the diagnosis and staging of pancreatic cancer. Tumori. 1999;85(1 Suppl):S14–8.

    Google Scholar 

  16. Witt BL, Hilden K, Scaife C, et al. Identification of factors predictive of malignancy in patients with atypical biliary brushing results obtained via ERCP. Diagn Cytopathol. 2013;41(8):682–8.

    Article  PubMed  Google Scholar 

  17. Taylor AJ, Carmody TJ, Schmalz MJ, et al. Filling defects in the pancreatic duct on endoscopic retrograde pancreatography. AJR Am J Roentgenol. 1992;159:1203–8.

    Article  CAS  PubMed  Google Scholar 

  18. Ohto M, Saotome N, Saisho H, et al. Real-time sonography of the pancreatic duct: application to percutaneous pancreatic ductography. AJR Am J Roentgenol. 1980;134:647–52.

    Article  CAS  PubMed  Google Scholar 

  19. Ladas SD, Tassios PS, Giorgiotis K, et al. Pancreatic duct width: its significance as a diagnostic criterion for pancreatic disease. Hepatogastroenterology. 1993;40(1):52–5.

    CAS  PubMed  Google Scholar 

  20. Yamao K, Kajikawa M. Early diagnosis of pancreatic cancer: re-evaluation of endoscopic retrograde cholangiopancreatography. Gan No Rinsho. 1983;29(10):1097–103.

    CAS  PubMed  Google Scholar 

  21. Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237:74–85.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pugliese V, Pujic N, Saccomanno S, et al. Pancreatic intraductal sampling during ERCP in patients with chronic pancreatitis and pancreatic cancer: cytologic studies and K-ras-2 codon 12 molecular analysis in 47 cases. Gastrointest Endosc. 2001;54(5):595–9.

    Article  CAS  PubMed  Google Scholar 

  23. Macken E, Drijikoningen M, Van Aken E, et al. Brush cytology of ductal strictures during ERCP. Acta Gastroenterol Belg. 2000;63(3):254–9.

    CAS  PubMed  Google Scholar 

  24. Glasbrenner B, Ardan M, Boeck W, et al. Prospective evaluation of brush cytology of biliary strictures during endoscopic retrograde cholangiopancreatography. Endoscopy. 1999;31(9):712–7.

    Article  CAS  PubMed  Google Scholar 

  25. Rosch T, Hofrichter K, Frimberger E, et al. ERCP and EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004;60(3):390–6.

    Article  PubMed  Google Scholar 

  26. Canto MI, Goggins M, Hruban RH, et al. Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol. 2006;4:766–81.

    Article  PubMed  Google Scholar 

  27. Ross WA, Wasan SM, Evans DB, et al. Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc. 2008;68(3):461–6.

    Article  PubMed  Google Scholar 

  28. Draganov PV, Chauhan S, Wagh MS, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012;75:347–53.

    Article  PubMed  Google Scholar 

  29. Stewart CJ, Mills PR, Carter R, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol. 2001;54:449–55.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Volmar KE, Vollmer RT, Routbort MJ, et al. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer. 2006;108:231–8.

    Article  PubMed  Google Scholar 

  31. Scheiman JM, Carlos RC, Barnett JL, et al. Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol. 2001;96(10):2900–4.

    Article  CAS  PubMed  Google Scholar 

  32. Parsi MA, Jang S, Sanaka M, Stevens T, et al. Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope. Gastrointest Endosc. 2014;79(6):936–42.

    Article  PubMed  Google Scholar 

  33. Chandler JE, Lee CM, Babchanik AP, et al. Evaluation of a novel, ultrathin, tip-bending endoscope in a synthetic force-sensing pancreas with comparison to medical guide wires. Med Dev. 2012;5:1–12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL, USA

    Ioana Smith

  2. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA

    Michel Kahaleh MD, AGAF, FACG, FASGE

Authors
  1. Ioana Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Kahaleh MD, AGAF, FACG, FASGE
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Kahaleh MD, AGAF, FACG, FASGE .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Mihir S. Wagh

  2. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Peter V. Draganov

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Smith, I., Kahaleh, M. (2016). The Role of ERCP in Diagnosing Pancreatic Masses. In: Wagh, M., Draganov, P. (eds) Pancreatic Masses. Springer, Cham. https://doi.org/10.1007/978-3-319-19677-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19677-0_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19676-3

  • Online ISBN: 978-3-319-19677-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation