Accuracy Of Endoscopic Retrograde Cholangiopancreatography Research Articles

Diagnosis of malignant biliary obstruction: pondering over the ERCP, MRCP and histology.

ObjectiveTo compare the diagnostic accuracy of endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance pancreatography (MRCP) and histological examination for malignant biliary obstruction.MethodsThis retrospective study included patients admitted for biliary obstruction caused by biliary tree malignancy that underwent ERCP, MRCP and histological examination. Data were collected from the medical records. The primary endpoints were the area under the receiver operating characteristic (AUROC) curve value, sensitivity, specificity and overall diagnostic accuracy of the three procedures in terms of a final diagnosis of obstructive biliary malignancy; and the agreement between ERCP, MRCP and histological examination with the final diagnosis.ResultsA total of 160 patients were included in the study (85 males, 53.1%; mean ± SD age, 69.31 ± 10.96 years). Considering the final diagnosis, the performance of MRCP, ERCP and histology in assessing biliary tumours produced AUROC values of 0.88 (95% confidence interval [CI] 0.75, 0.90), 0.94 (95% CI 0.85, 0.99) and 0.80 (95% CI 0.70, 0.82), respectively. ERCP presented higher sensitivity, overall diagnostic accuracy and agreement with the final diagnosis than MRCP and histological examination.ConclusionThese current data suggest that invasive methods such as ERCP with biopsy remain more reliable than non-invasive methods.

Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation.

BACKGROUNDAbnormal liver function tests (LFTs) in post-liver transplant (LT) patients pose a challenge in the timing and selection of diagnostic modalities. There are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography (ERCP) and liver biopsy (LB) in diagnosing post-transplant complications. AIMTo evaluate the diagnostic performance of ERCP and LB in patients with non-vascular post-LT complications.METHODSThis single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to 2017. Diagnostic operating characteristics including accuracy, sensitivity and specificity for various diagnoses were calculated for ERCP and LB. The R factor (ratio of alkaline phosphatase to alanine aminotransferase) was also calculated for each patient. RESULTSOf the 1284 patients who underwent LT, 91 patients (74.7% males, mean age of 51) were analyzed. Anastomotic strictures (AS, 24.2%), acute cellular rejection (ACR, 11%) and concurrent AS/ACR (14.3%) were the most common diagnoses. ERCP carried an accuracy of 79.1% (95%CI: 69.3-86.9), LB had an accuracy of 93.4% (95%CI: 86.2-97.5), and the combination of the two had an accuracy of 100% (95%CI: 96-100). There was no difference between patients with AS and ACR in mean R factor (AS: 1.9 vs ACR: 1.1, P = 0.24). Adverse events did not differ between the two tests (ERCP: 3.1% vs LB: 1.1%, P = 0.31). CONCLUSIONIn patients with abnormal LFTs after LT without vascular complications, the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone.

INTRADUCTAL ULTRASONOGRAPHY IN THE DIAGNOSIS OF BILE DUCT STONES: WHEN AND WHOM?

Biliary intraductal ultrasonography (IDUS) is highly sensitive in visualizing bile duct stones (BDS). Indications for IDUS, however, in cases of suspected BDS have not yet been established. The aim of the present study was to elucidate adequate indications for IDUS in cases that undergo endoscopic retrograde cholangiopancreatography (ERCP) due to suspected BDS. A total of 213 patients who were suspected of having BDS were included in this retrospective study. The patients were divided into two groups: Group A in which BDS was visualized by ERCP; and Group B in which BDS was demonstrated only by IDUS. Comparison between the groups was carried out. ERCP successfully visualized BDS in 166 patients. Forty-seven patients underwent IDUS, which revealed BDS and biliary sludge in 12 and eight patients, respectively. The diameter of the largest stone was 13 ± 6 mm in Group A and 5 ± 1 mm in Group B (P < 0.001). The sensitivity, specificity, and accuracy of ERCP in the diagnosis of BDS were 93%, 100%, and 94%, respectively. The sensitivity was influenced by the size of BDS: 100% in cases of stones ≥ 8 mm in size, but 74% in those with stones < 8 mm. In cases with stones < 8 mm, the sensitivity was significantly affected by the bile duct diameter (≥ 12 mm vs < 12 mm, P < 0.05). When ERCP fails to visualize stones in patients with suspected BDS, IDUS is recommended, especially in those with a bile duct ≥ 12 mm in diameter.

Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for diagnosis of chronic pancreatitis

The diagnosis of chronic pancreatitis is based on altered pancreatic morphology and function. A spectrum of disease exists, and milder forms of disease may be missed by CT but demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). The accuracy of ERCP and EUS for diagnosis of "minimal change" or "early" chronic pancreatitis is controversial, particularly when the results from these imaging procedures are discordant with each other or with tests of pancreatic function; in some cases ERCP and EUS should be considered indeterminate for diagnosis. This review discusses recent data concerning the accuracy of ERCP and EUS for diagnosis of chronic pancreatitis, the use of EUS fine-needle aspiration for differential diagnosis of pancreatic masses, and the use of EUS and EUS-guided TruCut biopsy for diagnosis of autoimmune pancreatitis.

Diagnostic Endoscopic Retrograde Cholangiopancreatography

Although diagnostic endoscopic retrograde cholangiopancreatography (ERCP) has been replaced in many fields by magnetic resonance cholangiopancreatography (MRCP), considerable amounts of research are still ongoing. Major fields of interest include ways of reducing the incidence of post-ERCP pancreatitis, new ways of improving the yield of tissue sampling, and the diagnosis of sphincter of Oddi dysfunction. In addition, there are new data comparing the diagnostic accuracy of ERCP with that of MRCP and endoscopic ultrasonography.

Clinical and Pathologic Correlations in Patients With Periampullary Tumors

Perioperative data on 87 patients undergoing pancreatoduodenectomy for periampullary tumors were correlated with pathologic study of operative specimens to identify the accuracy of diagnosis and the factors affecting survival. Accuracy of endoscopic retrograde cholangiopancreatography and computed tomography in locating lesions was 75% and 44%, respectively. Histologic diagnosis before or at the time of resection was available in only 61% of the patients. Carcinoma was correctly diagnosed clinically by the pathologist or the surgeon in 95% (83/87) of patients with 4 patients found to have benign disease on final pathologic examination. Intraoperative diagnosis of site of origin was incorrect in 18% (16/87) of patients. In 28% (23/83) of patients, pathologists identified nodal metastatic disease missed by the surgeon. Survival correlated with nodal and margin status and tumor grade. Tumor size demonstrated no predictive capacity. Although preoperative diagnostic accuracy is less than optimal, surgeons can usually diagnose malignant lesions but more often fail to identify tumor origin and nodal disease. We continue to advocate resection for patients with periampullary lesions thought to be malignant and resectable without a positive histologic diagnosis.

Carcinoma of the head of the pancreas: Therapeutic implications of endoscopic retrograde cholangiopancreatography findings

During a 10-yr period starting January 1973, 123 patients with a carcinoma at the head of the pancreas underwent endoscopic retrograde cholangiopancreatography at our hospital. Analysis of their case histories revealed that the early complaints of pancreatic head carcinoma are rather nonspecific—sudden onset of diabetes mellitus (33.3%), weight loss (80.5%), tiredness and malaise (42.3%), change in bowel habits (41.5%), and upper abdominal discomfort (22.0%)—and that jaundice (88.6%) and classic pain (70.7%) are late symptoms. The diagnostic accuracy of endoscopic retrograde cholangiopancreatography (92.7%) was much higher than that of computed tomography (58.5%) and echography (54.4%). The patients were divided according to the maximal tumor diameter into three groups: group 1, tumor diameter ranging between 2.5 and 4.0 cm; group 2, tumor diameter ranging between 4.5 and 6.0 cm; and group 3, tumor diameter ranging between 7.0 and 15.0 cm. The tumor diameter did not correlate with the degree of differentiation. Extension of the tumor, vascular involvement, and metastases were evaluated for the several tumor diameters. The tumor was, in principle, operable in 77% of group 1 patients; in 24% of group 2 patients; and in 9% of group 3 patients. Tumors <3 cm in diameter were always resectable; tumors >8 cm in diameter were seldom (9%) resectable. A curative resection was performed in 22.0% of the patients. The 4-yr survival of these patients was 44% as opposed to no survivors among the patients who had received only palliative or symptomatic treatment. During the decade, there was a tendency toward the diagnosis of smaller tumors (mean tumor diameter decreased from 9.0 ± 1.7 to 5.4 ± 2.8 cm) with a higher chance of resectability (from 25% to 44%).

Accuracy of endoscopic retrograde cholangiopancreatography (ERCP) in differentiating benign and malignant pancreatic disease

Despite advent of CT and ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) remains useful in the preoperative evaluation of the pancreas. Using radiographic criteria previously described, ERCP was accurate in 90% of 71 patients in differentiating benign from malignant disease. Diagnostic errors were caused by chronic pancreatitis mimicking carcinoma (N=4) and carcinoma developing in a gland with chronic pancreatitis (N=3) missed on ERCP. Chronic pancreatitis was associated with a normal ERCP in 10% (N=4) of patients.

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulation of the papilla of Vater followed by contrast radiology of the biliary and pancreatic ducts. With experience, X-ray films of the desired duct(s) can be obtained in 90% of patients, with minimal patient discomfort and a low frequency of complications. Retrograde cholangiography accurately assesses the site and cause of biliary tract obstruction. Retrograde pancreatography reveals ductal abnormalities in most patients with chronic pancreatitis and pancreatic cancer, and the nature of the abnormality usually permits differentiation of the two diseases. The diagnostic accuracy of ERCP is enhanced by cytological evaluation of pure pancreatic juice, while endoscopic sphincterotomy is a therapeutic option in selected patients with choledocholithiasis and papillary stenosis. Current developments include endoscopic aspiration biopsy of the pancreas and endoscopy of pancreatic and biliary ducts, using a miniature endoscope passed down a channel in the parent instrument.

Diagnostic Accuracy of Endoscopic Retrograde Cholangiopancreatography in Hepatic, Biliary, and Pancreatic Malignancy

This paper reports the radiographic findings in 84 cases of biopsy-proven pancreatic and biliary malignancies studied by endoscopic retrograde cholangiopancreatography. In the 73 successful studies a diagnosis of tumor could be made in 67 patients (92%). The study was successful in 40 of 43 patients with pancreatic carcinoma and the diagnosis could be made in 37 on the basis of stenosis or obstruction of the ducts. There were 33 successful studies in the 41 patients with miscellaneous tumors including primary bile duct, ampullary, gallbladder, metastatic carcinoma, lymphoma, and hepatoma. A diagnosis of tumor was made in 30 studies. As has been observed in carcinoma of other hollow structures, the hallmark of malignancy in the pancreatic and biliary tract is obstruction and stenosis. This study indicates that malignant disease of the pancreas and tract is accurately assessed by this endoscopic method.