Cholangiopancreatoscopy and Endoscopic Ultrasound for Indeterminate Pancreaticobiliary Pathology
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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.
The purpose of this study was to compare the yield of EUS and CP for the diagnosis of PB pathology.
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.
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).
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.
KeywordsCholangioscopy Pancreatoscopy ERCP EUS Cholangiocarcinoma Pancreatic cancer
The authors are indebted to the tireless efforts of our late colleague, Dr. Yang K. Chen, who contributed to the data. His pioneering work in the field of cholangiopancreatoscopy continues to serve as an inspiration and benchmark to our own aspirations.
Conflict of interest
Dr. Raj J. Shah received unrestricted educational grants from Boston Scientific and Olympus, Inc. No other authors reported pertinent disclosures. IRB approval was obtained to perform the data collection.