In the setting of suspected biliary obstruction, particularly if there is high concern for CBD stones or malignant obstruction, ERCP may be performed as the initial diagnostic and therapeutic imaging modality [68]. ERCP is very sensitive for detecting biliary ductal calculi [26,53]. However, as an interventional procedure, ERCP has risk of between 4% (111 of 2,769) up to 5.2% (872 of 16,855) of major complications (pancreatitis, cholangitis, hemorrhage, and perforation), with a 0.4% (11 of 2,769) mortality risk [69,70]. These factors need to be weighed against the potential benefits of ERCP [53,68,71,72]. The main indication for ERCP remains management of CBD stones, which can be cleared via balloon sweep of the duct in 80% to 95% of cases [71,73]. In stones >15 mm in size, ERCP alone is often not successful in removing the stone, and other advanced endoscopic techniques are needed [74,75]. US Abdomen Endoscopic EUS is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope equipped with an US probe into the duodenum, with sonographic images obtained of the pancreaticobiliary tree. EUS may be performed with a concomitant fine-needle aspiration (FNA) or biopsy. EUS offers high-resolution sonographic imaging of the head of the pancreas/distal CBD, and as such can be used to detect small distal biliary ductal calculi, can locally stage pancreatic or periampullary neoplasms, and can guide FNA or biopsy [76-80]. EUS is limited by its narrow field of view and therefore cannot detect pathology outside of its imaging field of view (ie, cannot see pathology beyond the region to which the sonographic probe is physically adjacent) [81,82]. Complications from EUS have been reported in up to 6.3% of patients (most commonly postprocedural pancreatitis) [83].
Jaundice. In the setting of suspected biliary obstruction, particularly if there is high concern for CBD stones or malignant obstruction, ERCP may be performed as the initial diagnostic and therapeutic imaging modality [68]. ERCP is very sensitive for detecting biliary ductal calculi [26,53]. However, as an interventional procedure, ERCP has risk of between 4% (111 of 2,769) up to 5.2% (872 of 16,855) of major complications (pancreatitis, cholangitis, hemorrhage, and perforation), with a 0.4% (11 of 2,769) mortality risk [69,70]. These factors need to be weighed against the potential benefits of ERCP [53,68,71,72]. The main indication for ERCP remains management of CBD stones, which can be cleared via balloon sweep of the duct in 80% to 95% of cases [71,73]. In stones >15 mm in size, ERCP alone is often not successful in removing the stone, and other advanced endoscopic techniques are needed [74,75]. US Abdomen Endoscopic EUS is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope equipped with an US probe into the duodenum, with sonographic images obtained of the pancreaticobiliary tree. EUS may be performed with a concomitant fine-needle aspiration (FNA) or biopsy. EUS offers high-resolution sonographic imaging of the head of the pancreas/distal CBD, and as such can be used to detect small distal biliary ductal calculi, can locally stage pancreatic or periampullary neoplasms, and can guide FNA or biopsy [76-80]. EUS is limited by its narrow field of view and therefore cannot detect pathology outside of its imaging field of view (ie, cannot see pathology beyond the region to which the sonographic probe is physically adjacent) [81,82]. Complications from EUS have been reported in up to 6.3% of patients (most commonly postprocedural pancreatitis) [83].