In patients with suspected malignant biliary obstruction and negative or equivocal CT or MRI examinations, ERCP with EUS may provide an imaging and cytologic diagnosis (FNA) [78,120]. As an interventional procedure, ERCP has risk of between 4% (111 of 2,769) to 5.2% (872 of 16,855) for 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 in 80% to 95% of cases [71,73]. ERCP also remains the standard procedure for stent placement in cases of obstructive jaundice. When deployed for distal CBD strictures, stenting via ERCP is successful in more than 90% of cases [115]. For diagnostic yield from ERCP-guided FNA of biopsies of solid pancreatic neoplasms, ERCP demonstrated sensitivity between 57.1% (for pancreatic body/tail neoplasms) and 82.4% (for pancreatic head neoplasms) [116]. Endoscopic or percutaneous transhepatic biliary drainage is appropriate for patients who are not candidates for surgery and may even be useful in operative candidates for whom there is a delay to definitive surgical resection. Standard ERCP is sufficient in 90% to 95% of patients who require biliary decompression. Factors that contribute to ERCP failure include gastric outlet or duodenal obstruction that is due to tumor invasion, or altered anatomy from diverticula or prior surgery. Percutaneous transhepatic cholangiography as well as EUS-guided biliary drainage are both effective for biliary decompression [117]. 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.
Jaundice. In patients with suspected malignant biliary obstruction and negative or equivocal CT or MRI examinations, ERCP with EUS may provide an imaging and cytologic diagnosis (FNA) [78,120]. As an interventional procedure, ERCP has risk of between 4% (111 of 2,769) to 5.2% (872 of 16,855) for 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 in 80% to 95% of cases [71,73]. ERCP also remains the standard procedure for stent placement in cases of obstructive jaundice. When deployed for distal CBD strictures, stenting via ERCP is successful in more than 90% of cases [115]. For diagnostic yield from ERCP-guided FNA of biopsies of solid pancreatic neoplasms, ERCP demonstrated sensitivity between 57.1% (for pancreatic body/tail neoplasms) and 82.4% (for pancreatic head neoplasms) [116]. Endoscopic or percutaneous transhepatic biliary drainage is appropriate for patients who are not candidates for surgery and may even be useful in operative candidates for whom there is a delay to definitive surgical resection. Standard ERCP is sufficient in 90% to 95% of patients who require biliary decompression. Factors that contribute to ERCP failure include gastric outlet or duodenal obstruction that is due to tumor invasion, or altered anatomy from diverticula or prior surgery. Percutaneous transhepatic cholangiography as well as EUS-guided biliary drainage are both effective for biliary decompression [117]. 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.