Clinical implications of endoscopic ultrasound: the American Endosonography Club Study

Nickl, Nicholas; Bhutani, Manoop S.; Catalano, Marc F.; Hoffman, Brenda J.; Hawes, Robert H.; Chak, Amitabh; Roubein, Leor D.; Kimmey, Michael B.; Johnson, Marian S.; Affronti, John; Canto, M. I.; Sivak, Michael; Boyce, H. Worth; Lightdale, Charles J.; Stevens, Peter D.; Schmitt, Colleen M.

doi:10.1016/s0016-5107(96)70083-4

Cited by 114 publications

(57 citation statements)

References 11 publications

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“…16,17 EUS is a safe procedure with very low complication rates and is often used to evaluate patients with dilated duct(s). 8 Previous studies have evaluated the utility of EUS in evaluating dilated CBD and PD. Similar to Malik et al, we found that patients with a dilated CBD and abnormal LFT were more likely to have findings on EUS to explain the dilated common bile duct.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are often selected to further evaluate patients with a dilated PD or CBD given their favorable complication profile. [8][9][10] The etiology of a patient's dilated duct can be explored with further investigation via MRCP, EUS or ERCP. 11,12 In the majority of cases, the etiology for the dilated duct(s) is benign but clinicians are always concerned for an underlying neoplasm.…”

Section: Introductionmentioning

confidence: 99%

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Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

jig

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Background:Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts. Objective: Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts. Design: Retrospective database analysis. Setting: Tertiary-care university hospital. Patients: Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included. Interventions: An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed. Main Outcome Measurements: The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD. Results: A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS. Limitations: A retrospective study with a small number of patients. Conclusion: Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

jig

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“…For most patients, endoscopic ultrasound evaluation leads to less invasive and costly treatments. [13][14][15][16] Single-and multicentre studies have shown an increase in the application of endoscopic ultrasonography over time; 17,18 however, these findings may not be generalizable to broader populations. Furthermore, little is known about regional Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study trends in use.…”

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confidence: 99%

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

et al. 2017

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Background: Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. Methods:We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. Results:We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas.Interpretation: Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs-and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province. AbstractResearch Research CMAJ OPEN E438CMAJ OPEN, 5(2)

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“…In particular, when dealing with staging a known cancer of the esophagus, EUS findings resulted in a major management change in 24% of 43 patients. Quite often, surgery was avoided in patients who would not have benefited from it because EUS demonstrated known neoplasms to be more advanced than had been suspected [2]. The same results were obtained in 63 patients by Jafri et al [3], who demonstrated that EUS led to a less invasive and less costly course of therapy in 67% of patients.…”

Section: Eus Rate Amentioning

confidence: 84%

Endoscopic Ultrasonography

Caletti¹,

Fusaroli²,

Buracco³

1998

Digestion

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Endoscopic ultrasonography (EUS) is nowadays a clinically relevant technology and its findings can have a major impact on patient management. This technique is currently indicated for staging digestive cancers, assessment of submucosal tumors, diagnosis of intestinal wall infiltrative diseases, common bile-duct stones and gut neuroendocrine tumors. As far as neoplasms are concerned, EUS appears to be a reliable and safe technique, thus making the physician able to plan either an aggressive surgical treatment, or a conservative palliative therapy. This is of the utmost importance in order to optimize medical-related costs, and to make the best therapeutic decision for each individual patient. EUS is also helpful in monitoring the course of a disease, as it is simple and virtually without complications. When EUS findings are not sufficient for a complete diagnosis, it is now possible to perform an EUS-guided fine-needle biopsy, which can allow a cytological diagnosis. Finally, some therapeutic endosonography-guided procedures are being increasingly adopted, such as cystoenterostomy, celiac plexus neurolysis, cholangio-pancreatography and selective injection of botulinum toxin in the muscle layer of the lower esophageal sphincter.

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Clinical implications of endoscopic ultrasound: the American Endosonography Club Study

Cited by 114 publications

References 11 publications

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study

Endoscopic Ultrasonography

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