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Place respective de l’échoendoscopie et de la CPRE dans les pathologies biliopancréatiques

The respective role of endoscopic ultrasonography and ERCP in biliopancreatic pathology

  • Published:
Acta Endoscopica

Conclusion

L’EE et la CPRE ont trouvé progressivement leur place dans l’étude de la sphère biliopancréatique. Les performances de l’EE ont entrainé la disparition de la CPRE à visée diagnostique dans un grand nombre de cas (suspicion de tumeur pancréatique,…). Dans d’autres domaines, la place des deux examens reste complémentaire (diagnostic précoce de pancréatite chronique, pancréatite aigüe) ou à adapter en fonction de chaque cas particulier (LVBP, bilan de cholestase extrahépatique). Le choix doit alors être fait entre — le risque potentiel de la CPRE dans des cas où elle ne serait pas thérapeutique et où l’EE pour-rait être aussi efficace pour le diagnostic — la réalisation d’une EE inutile si quelque soit son résultat, c’est une CPRE thérapeutique qui est envisagée. Dans quelques rares cas, seule la CPRE garde une place du fait des limites de l’EE (pancréas divisum, tumeurs du hile, recherche d’une cholangite sclérosante).

Toutes ces données pourront dans les années à venir être remises en cause par les nouveaux examens diagnostiques qui se développent actuellement (TDM hélicoïdale, IRM, échographie par cœlioscopie…). Dans tous les cas, ces examens devront se confronter à l’EE, principalgold standard actuel des pathologies biliopancréatiques.

Conclusion

EU and ERCP have each found their place in the examination of the biliopancreatic region. The performance of EU has led to the replacement of ERCP in the diagnosis of a large number of cases (suspected pancreatic tumours,…).

In other circumstances, the place of the two examinations remains either complementary (early diagnosis of chronic pancreatitis, acute pancreatitis) or they have to be adapted according to each particular case (CBDL, assessment of extrahepatic cholestasis). The choice then lies between the potential risk of ERCP, in cases where it would not be therapeutic and where the EU would be just as effective for the diagnosis, and carrying out a needless EU, whatever its result, if ERCP therapy is envisaged anyhow. In only certain rare cases does ERCP maintain its place because of the limitations of EU (pancreas divisum, tumours of the hilum, detection of sclerosing cholangitis).

All these data could be challenged in the coming years by new diagnostic examinations which are being developed at present (helical CT scan, MRI, coelioscopic ultrasonography…). In any case, these examinations will have to be compared to EU, which is the present day gold standard for biliopancreatic diseases.

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  1. B. Napoléon

    Present address: Clinique Saint-Jean, 35, rue Bataille, 69008, Lyon, France

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Napoléon, B. Place respective de l’échoendoscopie et de la CPRE dans les pathologies biliopancréatiques. Acta Endosc 26, 345–353 (1996). https://doi.org/10.1007/BF02968847

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