The sensitivity, specificity, and accuracies of EUS with FNA biopsy for solid pancreatic tumor are 90.8%, 96.5%, and 91%, respectively [79,84,85]. There is a very limited role for EUS in the initial evaluation of a jaundiced patient. There are some studies from the gastroenterology literature that report high success of EUS in detection of tiny CBD stones that are <4 mm; however, generally, if the patient has a cholestatic presentation with a dilated CBD, the CBD will be presumptively swept at the time of ERCP without using an EUS to confirm this diagnosis [86]. Variant 2: Jaundice. Suspected mechanical obstruction based on initial imaging, clinical condition, or laboratory values. Obstructive jaundice (conjugated hyperbilirubinemia) is jaundice resulting from obstruction to the flow of bile from the liver to the duodenum. The differential diagnosis of jaundice that is due to biliary obstruction in adults includes intrinsic and extrinsic tumors, choledocholithiasis, primary sclerosing cholangitis, parasitic infections, lymphoma, AIDS cholangiopathy, acute and chronic pancreatitis, and strictures after invasive procedures [12,32]. The panel concurs with multiple other society recommendations [32,86-89], that the usual initial imaging evaluation of a patient presenting with conjugated hyperbilirubinemia will include a right upper quadrant US. US will be able to confirm an obstructive process (dilatation of the intrahepatic or extrahepatic biliary tree) and may be able to localize the site of the obstruction (CBD, gallbladder, biliary bifurcation, pancreatic head) and show whether it is likely benign (choledocholithiasis, cholecystitis) or malignant (Klatskin tumor, pancreatic head mass, hepatic mass, etc), thus pointing to the best next test (or intervention) for further workup. US Abdomen US is a noninvasive imaging technique that effectively evaluates obstructive jaundice [89,90].
Jaundice. The sensitivity, specificity, and accuracies of EUS with FNA biopsy for solid pancreatic tumor are 90.8%, 96.5%, and 91%, respectively [79,84,85]. There is a very limited role for EUS in the initial evaluation of a jaundiced patient. There are some studies from the gastroenterology literature that report high success of EUS in detection of tiny CBD stones that are <4 mm; however, generally, if the patient has a cholestatic presentation with a dilated CBD, the CBD will be presumptively swept at the time of ERCP without using an EUS to confirm this diagnosis [86]. Variant 2: Jaundice. Suspected mechanical obstruction based on initial imaging, clinical condition, or laboratory values. Obstructive jaundice (conjugated hyperbilirubinemia) is jaundice resulting from obstruction to the flow of bile from the liver to the duodenum. The differential diagnosis of jaundice that is due to biliary obstruction in adults includes intrinsic and extrinsic tumors, choledocholithiasis, primary sclerosing cholangitis, parasitic infections, lymphoma, AIDS cholangiopathy, acute and chronic pancreatitis, and strictures after invasive procedures [12,32]. The panel concurs with multiple other society recommendations [32,86-89], that the usual initial imaging evaluation of a patient presenting with conjugated hyperbilirubinemia will include a right upper quadrant US. US will be able to confirm an obstructive process (dilatation of the intrahepatic or extrahepatic biliary tree) and may be able to localize the site of the obstruction (CBD, gallbladder, biliary bifurcation, pancreatic head) and show whether it is likely benign (choledocholithiasis, cholecystitis) or malignant (Klatskin tumor, pancreatic head mass, hepatic mass, etc), thus pointing to the best next test (or intervention) for further workup. US Abdomen US is a noninvasive imaging technique that effectively evaluates obstructive jaundice [89,90].