Clinical Outcomes and Efficacy of a New Endoscopic Ultrasound Program in a Community Hospital

Abstract

Introduction: Endoscopic ultrasound (EUS) is a safe alternative to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic pancreaticobiliary imaging in various benign and malignant conditions. Studies have shown the accuracy of EUS to be comparable and even superior to ERCP for diagnosing pancreaticobiliary diseases but with fewer side effects. The main side effect of ERCP is post-ERCP pancreatitis which can be avoided in certain conditions where therapeutic intervention is not necessary. Both procedures can be combined into a single EUS-ERCP session for management of obstructive jaundice. In this study, we investigated the clinical outcomes and efficacy of starting a new EUS program, as well as the impact of combining EUS with ERCP in a single endoscopic session. Methods: In a retrospective study, EUS and combined EUS-ERCP procedures performed over a period of three years were selected. Data was collected regarding indications, outcomes, interventions, and complications. Clinical indications, outcomes, and complications were analyzed with two-way ANOVA test and Fisher's exact test. Results: A total of 766 EUS performed over a 3-year period between 2013 and 2015 were included in the study, out of which 130(16.9%) were combined EUS-ERCP in a single endoscopic session. There was a 39.6% relative increase in the number of EUS performed with a p-value of <0.0001. The success rate for EUS and EUS-ERCP was 99.8% and 97% respectively. There were 33(25.3%) patients with malignancyrelated obstructive jaundice who underwent combined EUS-ERCP for diagnosis and relieving obstruction in a single session. Fine needle aspiration was performed in 313(49.2%) cases in EUS and 53(40.7%) in EUS-ERCP. Complications were noted to be acute pancreatitis [3(0.47%) vs 11(8.4%)] and abdominal pain [8(1.2%) vs 10(7.6%)]. A total of 70[(11%) confidence interval (CI) ± 2] ERCP procedures were saved by doing EUS, resulting in prevention of acute pancreatitis (0.7%, CI: 0.4). Conclusion: We are reporting our experience of the introduction of EUS as a new service in a community hospital showing high success and low complication rate and is associated with avoiding unnecessary ERCP procedures thus protecting against ERCP related complications. Combining EUS-ERCP procedures resulted in significant impact on patients with obstructive jaundice by diagnosing and relieving obstruction in one endoscopic session.777_A Figure 1. Graph representing an increase in the volume of EUS over the course of 3 years (39.6% relative increase; p <0.0001). FNA was performed in 313(49.2%) cases which also shows relative increase.777_B Figure 2. Analysis of EUS and combined EUS-ERCP