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Management of Pancreatico-Biliary Disease: Endoscopic Ultrasound (EUS)

  • Robert D. Fanelli
  • Stephanie M. Fanelli
  • Josephine A. Fanelli
Chapter

Abstract

Biliary stone disease, pancreaticobiliary inflammation, pancreaticobiliary neoplasia, and incidental radiographic findings are among the most common indications for performing EUS. EUS routinely is used to investigate laboratory abnormalities and lesions identified on cross-sectional imaging and provides both additional diagnostic and therapeutic value, sparing some patients operative intervention. Clinical presentation, physical findings, biochemical analyses, TUS, CT, MRI, and ERCP all play important roles in the diagnosis and treatment of CBDS and other pancreaticobiliary disorders. None, however, is as effective as EUS for diagnosis of the various benign and malignant conditions impacting the biliary tree and pancreas.

EUS is a superior diagnostic tool for identifying CBDS and other biliopancreatic pathology. Using EUS to direct the application of ERCP renders the latter solely a therapeutic procedure, which limits the risks and costs of unnecessary interventions. The development of adjunctive devices, like lumen apposing metal stents (LAMS), has fueled the development of novel EUS-based approaches to CBDS in patients with surgically altered anatomy, drainage of pancreatic fluid collections and walled off pancreatic necrosis (WOPN), and extra-anatomic decompression of the obstructed biliary tree. These procedures, now becoming routine, benefit patients through increasingly less invasive therapy.

Keywords

EUS LAMS SEMS Choledocholithiasis Laparoscopic cholecystectomy Gallstones ERCP Endoscopic ultrasound Pancreatitis Jaundice Cholangitis Pancreatic pseudocyst Pancreatic cancer 

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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Robert D. Fanelli
    • 1
  • Stephanie M. Fanelli
    • 2
  • Josephine A. Fanelli
    • 3
  1. 1.The Guthrie Clinic, Department of Surgery, Geisinger Commonwealth School of MedicineSayreUSA
  2. 2.The Ohio State University College of Medicine, School of Health and Rehabilitation SciencesColumbusUSA
  3. 3.The Guthrie Clinic, Division of Endocrinology and Metabolism, Department of MedicineSayreUSA

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