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Combined Versus Separate Sessions of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for the Diagnosis and Management of Pancreatic Ductal Adenocarcinoma with Biliary Obstruction

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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.

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Funding

Evan L. Fogel, MSc, MD-Grant Funding: Consortium for the study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (CPDPC, 1U01DK108323-05), Administrative Supplement, Indiana University Clinical Center for Chronic Pancreatitis Clinical Research Network, Granting Agency: NIDDK (3U01DK108323-04S1), Sphincterotomy for Acute Recurrent Pancreatitis (SHARP, 1U01DK116743-01). Magnetic resonance Imaging as a Non-Invasive Method for Assessment of Pancreatic fibrosis (MINIMAP): a pilot study (1R01DK116963-01). Jeffrey J. Easler, MD- Grant Funding: Consortium for the study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC, 1U01DK108323-05), Boston Scientific: Consultant. Stuart Sherman, MD–Grant Funding: Consortium for the study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (CPDPC, 1U01DK108323-05), Boston Scientific: Consultant; Cook: Consultant. Glen Lehman, MD – Cook Medical: Consultant. Tugrul Purnak, MD, Ihab I. El Hajj, MD, MPH, Lee McHenry, MD, Mark A. Gromski, James L. Watkins MD, Mohammad Al-Haddad, John DeWitt MD have no disclosures or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, 6431 Fannin, MSB1.150, Houston, TX, 77030, USA

    Tugrul Purnak

  2. Division of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon

    Ihab I. El Hajj

  3. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd., Ste 1634, Indianapolis, IN, 46202, USA

    Stuart Sherman, Evan L. Fogel, Lee McHenry, Glen Lehman, Mark A. Gromski, Mohammad Al-Haddad, John DeWitt, James L. Watkins & Jeffrey J. Easler

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  1. Tugrul Purnak
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Correspondence to Jeffrey J. Easler.

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Purnak, T., El Hajj, I.I., Sherman, S. et al. 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, 2786–2794 (2021). https://doi.org/10.1007/s10620-020-06564-0

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