271 Biliary Drainage: How Often Is EUS-Guidance Really Needed?

Holt, Bronte A.; Hawes, Robert H.; Hasan, Muhammad; Canipe, Ashley; Tharian, Benjamin; Navaneethan, Udayakumar

doi:10.1016/j.gie.2015.03.045

Cited by 3 publications

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“…The data reported so far indicate that EUS-BD was required in 5-10% of the patients with failed ERCP; however, Holt et al . [ 17 ] questioned this number by performing an interesting analysis in a tertiary center where both standard and advanced cannulation techniques were used in ERCP. At their center, physicians performing ERCPs failed to cannulate only 0.6% of the patients with native papilla and these cases were managed by EUS-BD or PTBD.…”

Section: Endoscopic Ultrasound-guided Biliary Drainagementioning

confidence: 99%

New developments in endoscopic ultrasound-guided therapies

Bhutani

Arora

2015

Endosc Ultrasound

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Endoscopic ultrasound (EUS) has opened new horizons in minimally invasive therapies for diverse gastrointestinal pathologies. Digestive Disease Weak 2015 held in Washington, DC., USA featured exciting research articles on EUS-guided therapeutic procedures. EUS-guided biliary drainage has been attempted and described for many years. There seems to be a lot of interest among various international groups to compare this technique with other alternatives in terms of efficacy and safety. Similarly, EUS-guided pancreatic drainage of cysts and fluid collections continues to evolve with new stents and devices being developed specifically for deployment under endosonographic guidance. EUS-guided ablation of cystic pancreatic tumors is innovative but not always effective. Combining alcohol ablation with injecting chemotherapeutic agents may improve long-term results regarding efficacy. Similarly, for solid pancreatic tumors there appears to be ongoing interest and continuing efforts in injecting different chemotherapeutic or ablative agents, delivering fiducials for radiation guidance and even attempting ablation with radiofrequency. Gastric variceal treatment and EUS-guided anastomoses also continue to be investigated. This review article is focused on the recent developments in EUS-guided therapies presented at Digestive Disease Week (DDW) 2015.

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Section: Endoscopic Ultrasound-guided Biliary Drainagementioning

confidence: 99%

New developments in endoscopic ultrasound-guided therapies

Bhutani

Arora

2015

Endosc Ultrasound

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“…In a prospective study of 1000 consecutive ERCP carried out over an 11‐month period at a tertiary referral center, the authors attempted to identify the true need for EUS‐guided biliary drainage . After excluding patients who had undergone prior biliary stenting or sphincterotomy, 524 native papilla ERCP formed the study cohort.…”

Section: Eus‐guided Biliary Drainagementioning

confidence: 99%

Digestive Disease Week (DDW) 2015: Pancreaticobiliary update

Varadarajulu

Bang

2015

Digestive Endoscopy

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This update critiques the key abstracts relevant to endoscopic evaluation or interventions in pancreatic and biliary diseases that were presented at Digestive Disease Week (DDW) 2015. We selected 20 abstracts based on their clinical significance, relevance to endoscopic practice and impact on patient management Key words: biliary drainage, endoscopic retrograde cholangio pancreatography (ERCP), endoscopic ultrasonography (EUS), interventional EUS, pancreatic cysts EVALUATION AND TREATMENT OF PANCRE-ATIC CYST LESIONS S EVERAL ABSTRACTS WERE presented on the endoscopic evaluation and treatment of pancreatic cyst lesions. In a retrospective study of 321 patients with pancreatic cyst lesions who were followed for a mean duration of 31 months, only 10 patients were referred for surgery.1 In eight of 10 patients, the presumed diagnosis was found to be correct at surgery and no disease progression was found in any patient at follow up.In another study of 535 asymptomatic high-risk patients with intraductal papillary mucinous neoplasm (IPMN) who either had pancreatic cysts >5 mm or dilated main pancreatic duct >2.5 mm in diameter, surveillance was undertaken using pancreatic protocol ultrasound every 3 months, computed tomography (CT) or magnetic resonance imaging (MRI) every 12 months, and then endoscopic ultrasonography (EUS) if there were changes in the size of the cyst or duct morphology. 2 Thirteen (2.4%) cases of IPMN with malignancy were confirmed over a median follow-up duration of 34 months and seven of these 13 patients had multiple cysts <2 cm in size. The authors observed that cyst size alone may not be a major determinant in predicting cancer risk; multiple small cysts may be another feature that is predictive of progression to malignancy.A retrospective study of 364 patients with branch-duct (BD) IPMN attempted to identify predictors of malignancy and recurrence at long-term follow up.3 In this study, 135 of 364 patients underwent surgical resection and 229 underwent imaging surveillance. Among patients who underwent surgery, the presence of main pancreatic duct (MPD) dilation (5-9 mm) was more frequently associated with malignant lesions (P = 0.01). Following surgery, patients with malignant BD-IPMN had higher tumor recurrence rates (17 vs 7%, P = 0.03). Moreover, EUS features such as mural nodules, suspicious MPD (thick walls, mucin or mural nodule), suspicious or malignant cytology and MPD size of 5-9 mm on CT/MRI were strongly associated with malignant BD-IPMN. The accuracy of cytology, carcinoembryonic antigen (CEA) and amylase were evaluated in a cohort of 1167 patients with IPMN who underwent EUS-guided fine-needle aspiration (EUS-FNA).4 Sensitivity, specificity and accuracy of cytology for differentiating benign from malignant IPMN were 39%, 88% and 64%, respectively. At a cut-off value of 129 ng/mL, the sensitivity and specificity of CEA was only 76.9% and 83.3%, respectively, and cyst amylase analysis was diagnostically unhelpful.A retrospective study compared the clinical outcomes of pancreatic ...

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Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Clinical Assessment of Pancreatic Neoplasms

Varadarajulu

Bang

2016

Surgical Oncology Clinics of North America

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271 Biliary Drainage: How Often Is EUS-Guidance Really Needed?

Cited by 3 publications

References 0 publications

New developments in endoscopic ultrasound-guided therapies

New developments in endoscopic ultrasound-guided therapies

Digestive Disease Week (DDW) 2015: Pancreaticobiliary update

Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Clinical Assessment of Pancreatic Neoplasms

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