Diagnostic Yield Of Endoscopic Ultrasonography Research Articles

The Diagnostic Yield of Endoscopic Ultrasound in Asymptomatic Patients with Unexplained Dilated Common Bile Duct, or Double Duct Sign with Normal Transaminase a Retrospective Study from a Single Urban-based University Endoscopy Center.

Common bile duct dilatation alone or double duct sign (both CBD and dilated pancreatic duct dilatation) and abnormal liver enzymes are highly predictive of biliary disease. This can be identified on ultrasound (US), CT scan, and/or magnetic resonance cholangiopancreatography (MRCP). Unexplained dilatation on imaging might warrant endoscopic ultrasound (EUS) to identify any occult causes. Supporting literature about the importance of using EUS in these conditions is evolving with no clear evidence-based approach to evaluate asymptomatic dilated ducts.We aim to investigate the diagnostic yield of EUS in unexplained CBD dilatation or double duct sign with normal liver enzymes. A retrospective data analysis was conducted from January 2015 to October 2021 on asymptomatic patients with a dilatated CBD of 7 mm or more and 9 mm if the patient had a cholecystectomy history or double duct sign with normal liver enzymes. 32 EUS procedures were indicated for unexplained dilated CBD or double duct sign on imaging with normal liver enzymes. 23 had CBD dilatation alone (72 %), and 9 had a double duct sign (28 %). 20 of the included patients were females (63 %), and 12 were males (37 %), with a mean age of 63.8 ± 17 and 68.2 ± 14 years old, respectively (p = 0.424). The diagnosis after EUS in CBD dilatation alone showed a yield of 56 % as follow; no pathology in 10 (44 %), sludge in 9 patients (39 %), CBD stone in 3 (13 %), malignant stricture in 1 (4 %) (Fig. 1). On the other hand, EUS in those with double duct signs showed a diagnostic yield of 55 %; no pathology in 4 (45 %), pancreatic head adenocarcinoma in 3 patients (33 %), Biliary stone in one patient, and malignant CBD stricture in one patient (11 % each) (Fig. 2). Unexplained CBD dilatation or Double duct sign on imagining in patients with normal liver enzymes should warrant further investigation with EUS to avoid missing serious pathological conditions such as stones, sludge, stricture, or a mass.

Diagnostic Yield of Endoscopic Ultrasound in Intermediate Probability of Choledocholithiasis According to the ASGE Criteria

Diagnostic Yield of Endoscopic Ultrasound in Intermediate Probability of Choledocholithiasis According to the ASGE Criteria

2811 Outcomes of Endoscopic Ultrasonography (EUS) in Patients Referred for Biliary Dilation Without Significant Biochemical Cholestasis

INTRODUCTION: The diagnostic yield of endoscopic ultrasound (EUS) in non-jaundiced patients with unexplained biliary dilation has been reported to be 6-33%. In our experience, patients with unexplained biliary dilation who use chronic narcotic analgesics might have an even lower diagnostic yield at EUS. However, this correlation has not been well-described as yet. METHODS: We reviewed electronic medical records of patients referred to our center for EUS for the primary indication of unexplained biliary dilation between July 2007 and June 2017. Our database search yielded 767 potential subjects. Exclusion criteria included pancreaticobiliary masses, stones, or calcific chronic pancreatitis seen on prior imaging, a total serum bilirubin >3 mg/dl, or alkaline phosphatase (AP) > 1.5x the upper limit of normal. Data were also separately abstracted on patients with liver tests exceeding the above criteria, yet who had no other exclusion criteria. RESULTS: 41 patients met all inclusion and exclusion criteria. The mean age was 62.4 ± 14.5 years, 37 (90.2%) were female, the mean bile duct diameter at EUS was 12.2 ± 3.8 mm, total bilirubin was 0.6 ± 0.3 mg/dL and AP was 112 ± 62.9 U/L. Most patients (33/41, 80.5%) were symptomatic, reporting abdominal pain or weight loss. A majority (29/41, 70.7%) of patients used oral narcotics. EUS demonstrated choledocholithiasis in 3/29 patients (10.3%) using narcotics and 1/12 (8.3%) not using narcotics. No masses or other relevant pathology was observed. This patient cohort was then combined with 39 additional patients with unexplained biliary dilation who had abnormal liver biochemical tests. Multivariable logistic regression analysis revealed that patients with abnormal liver biochemical tests were 3 times more likely to have positive EUS finding (OR 2.9, CI [1.5,5.7], P = 0.002). Patients using chronic narcotic analgesics were less likely to have positive EUS finding (OR 0.3, CI [0.1, 1.1], P = 0.06). CONCLUSION: A majority of patients referred for EUS to investigate biliary dilation without biochemical cholestasis were women using chronic narcotic analgesics. The diagnostic yield of EUS in this population was low (9.8%) and no neoplasia was found. In contrast, the yield of EUS in patients with biliary dilation and elevated liver tests was strikingly higher at 85%. Use of chronic narcotic analgesics appeared to predict a reassuring EUS examination.

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies.

Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.

Collaboration of community hospital endosonographers improves diagnostic yield of endoscopic ultrasonography guided tissue acquisition of solid pancreatic lesions.

Background and study aims Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is the method of choice for establishing a pathological diagnosis of solid pancreatic lesions. Data on quality and yield of EUS-guided TA performed in community hospitals are lacking. A study was performed to determine and improve the diagnostic yield of EUS-guided TA in a group of community hospitals. Methods Following analysis of the last 20 EUS-guided TA procedures of solid pancreatic lesions performed in each of four community hospitals, a collaborative EUS interest group was formed and a prospective registry was started. During meetings of the interest group, feedback on results per center were provided and strategies for improvement were discussed. Results In the BEFORE team formation cohort, 80 procedures were performed in 66 patients. In the AFTER team formation cohort, 133 procedures were performed in 125 patients. After team formation, the rate of adequate sample increased from 80 % (95 %CI [0.7 – 0.9]) to 95 % (95 %CI [0.9 – 1.0]) , diagnostic yield of malignancy improved from 28 % (95 %CI [0.2 – 0.4]) to 64 % (95 % CI [0.6 – 0.7]), and sensitivity of malignancy improved from 63 % (95 %CI [0.4 – 0.8]) to 84 % (95 %CI [0.8 – 0.9]). Multivariate regression analysis revealed team formation to be the only variable significantly associated with an increased rate of adequate sample. Conclusions Formation of a regional EUS interest group with regular feedback on results per center, and discussions on methods and techniques used, significantly improved the outcome of EUS-guided TA procedures in patients with solid pancreatic lesions in community hospitals.

Diagnostic yield of endoscopic ultrasonography for a dilation of the common bile duct of an indeterminate cause

with the widespread use of abdominal imaging, common bile duct (CBD) dilation is a common problem in the daily practice. However, the significance of a dilated CBD as a predictor of underlying disease has not been well elucidated and there are currently no guidelines for its approach. this was a retrospective study of patients who underwent endoscopic ultrasonography (EUS) from 2010 to 2017 due to a dilated CBD detected by transabdominal ultrasonography TUS (CBD ≥ 7 mm) or computed tomography (CT) (CBD ≥ 10 mm), with no identified cause (n = 56). The aims were to assess the diagnostic yield of EUS and to identify predictors for a positive EUS. the majority of patients (n = 39) had normal findings on EUS. Abnormal EUS findings were found in 30% (n = 17) of the patients, which included choledocholithiasis (n = 6), ampuloma (n = 3), choledochal cyst (n = 2), benign CBD stenosis (n = 2), cyst of the head of the pancreas (n = 1), cholangiocarcinoma (n = 1), chronic pancreatitis (n = 1) and CBD compression due to adenomegaly (n = 1). Factors that positively related with findings on EUS were increased levels of gamma glutamyl transferase (331 U/l vs 104 U/l, p = 0.039), alkaline phosphatase (226 U/l vs 114 U/l, p = 0.041), total bilirubin (TB) (6.5 g/dl vs 1.2 g/dl, p = 0.035) and the presence of signs/symptoms (p = 0.042). Of the 21 patients (38%) who were asymptomatic with normal liver biochemical tests, four (19%) had findings on EUS. the majority of patients with a dilation of the CDB have a normal EUS. Increased cholestasis enzymes, increased TB and the presence of signs and symptoms are predictors of a positive EUS.

Mo2060 Diagnostic Yield of Endoscopic Ultrasound - Fine Needle Aspiration with Flow Cytometry and Core Needle Biopsy in the Diagnosis of Lymphoma

Mo2060 Diagnostic Yield of Endoscopic Ultrasound - Fine Needle Aspiration with Flow Cytometry and Core Needle Biopsy in the Diagnosis of Lymphoma

Su1295 Per-Pass Diagnostic Yield of Endoscopic Ultrasound Guided Fine Needle Aspiration of Malignant Solid Pancreatic Masses in a Large Multicenter Cohort

Su1295 Per-Pass Diagnostic Yield of Endoscopic Ultrasound Guided Fine Needle Aspiration of Malignant Solid Pancreatic Masses in a Large Multicenter Cohort

PTH-038 Diagnostic utility of further assessment with endoscopic ultrasound in patients with unexplained common bile duct obstruction with and without abnormal liver enzymes: Abstract PTH-038 Table 1

Introduction Patients who undergo endoscopic ultrasound (EUS) are often referred because of a dilated common bile duct (CBD) of unknown cause and/or abnormal liver enzymes (LFT). We aimed to determine the diagnostic yield when such patients are referred for an EUS for further assessment. Method All patients who underwent an EUS in 2010 were included. Patients who had an identifiable cause of pathology on prior imaging were excluded. We retrospectively analysed our electronic database for radiological evidence of CBD dilatation, laboratory values of LFT and results of the EUS. Results 184 patients were identified. 60 (32.6%) had a dilated CBD with normal LFT (group A), 65 (35.3%) had dilated CBD with abnormal LFT (group B), 36 (19.6%) had abnormal LFT with a normal CBD (group C), and 23 (12.5%) had normal LFT with a normal CBD (group D). Out of 184 patients, 78 (42.4%) received a diagnosis at EUS. The diagnostic yield of EUS when divided into groups were: A = 23.3% (14/60), B = 55.4% (36/65), C = 55.6% (20/36), D = 34.8% (8/23). There was a significant difference in diagnostic yield between groups A vs B and A vs C (p = Conclusion Patients with abnormal LFT were more likely to have a positive diagnosis at EUS than those with a dilated CBD. However there were substantive positive findings in all groups justifying further assessment with EUS even if prior imaging tests were normal. Disclosure of interest None Declared.

Influence of comorbidity on the prognosis of acute pancreatitis

s / Pancreatology 15 (2015) S1eS141 S67 Patients & methods: 309 consecutive patients admitted to our centre for acute pancreatitis received first-line investigations, including medical history, biological measurements, abdominal ultrasound and computerized tomography. If no aetiology was found, second-line investigations included biological parameters, endoscopic ultrasound (EUS), magneticresonance cholangiopancreatography (MRCP) and genetic testing in cases of idiopathic pancreatitis. Results: 66 patients aged between 16 and 35 years, were included (M: 36; mean age 26 years). They were compared to 243 patients (M: 157; mean age 60 years). After first-line investigations, 49% of cases of acute pancreatitis in young adults remained idiopathic. Second-line investigations reduced this rate to 21%. The frequency of aetiologies for acute pancreatitis significantly varied in young adults compared to older adults: less were biliary (23% versus 43%, p1⁄4 0.003) or alcohol (8% versus 24%, p1⁄4 0.01) related, morewere drug-induced (16% versus 4%, p1⁄4 0.0007), related to cannabis consumption (13% versus 1%, p <0.0001) or to genetic mutations (10% versus 1.5%, p 1⁄4 0.003). In young adults, the diagnostic yield of EUS and MRCP was low (13% of cases) and the use of both investigations was ineffective. MRCP should be solely proposed for this indication in young patients. Conclusion: Aetiologies of acute pancreatitis significantly differed in adults aged less than 35 years when compared to older patients. The medications, exposure to cannabis and genetic mutations should be researched.

The diagnostic yield of endoscopic ultrasonography in patients with suspected Choledocholithiasis

The diagnostic yield of endoscopic ultrasonography in patients with suspected Choledocholithiasis

Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center.

BackgroundDiagnosis of choledocholithiasis requires clinical manifestations and imaging examination findings suggesting a stone in the common bile duct (CBD), but these factors are not highly sensitive or specific. The choledocholithiasis management algorithm proposed by the American Society for Gastrointestinal Endoscopy (ASGE) may not be appropriate for patients who fulfill the clinical criteria for a high likelihood of choledocholithiasis. Endoscopic ultrasonography (EUS) may replace endoscopic retrograde cholangiopancreatography (ERCP) for the detection of CBD stones in all patients. The aims of this study were to determine the diagnostic yield and optimal timing of EUS in patients with an intermediate or high likelihood of choledocholithiasis requiring therapeutic ERCP.MethodsPatients with suspected choledocholithiasis who underwent EUS between June 2009 and January 2012 were retrospectively reviewed. The patients were divided into two groups based on the likelihood of choledocholithiasis according to the clinical predictors described by the ASGE guidelines: an intermediate likelihood group and a high likelihood group. The demographic data, clinical manifestations at presentation, blood test results, EUS and ERCP findings, and clinical manifestations during the follow-up period were recorded and analyzed.ResultsNinety-three patients were enrolled in the study (52.7% in the intermediate likelihood group and 47.3% in the high likelihood group). CBD stones were detected in 22.44% of patients in the intermediate likelihood group and 38.63% of patients in the high likelihood group. EUS had a sensitivity of 100% and specificity of 80% for detection of CBD stones. An alkaline phosphatase level of >133 mg/dL (area under the curve, 0.576) was the only factor that was significantly associated with detection of CBD stones in patients who underwent EUS >7 days after the initial clinical presentation (odds ratio 4.87, p = 0.01).ConclusionsEUS is an accurate diagnostic tool for the detection of CBD stones, and can prevent the unnecessary use of ERCP. This study found that use of clinical criteria alone might not provide a good prediction of the presence of CBD stones, even in patients who fulfill the criteria for a high likelihood of choledocholithiasis.

Factors Determining Diagnostic Yield of Endoscopic Ultrasound Guided Fine-Needle Aspiration for Pancreatic Cystic Lesions: A Multicentre Asian Study

The purpose of this study was to determine (1) the diagnostic yield for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with pancreatic cystic lesions, (2) additional value of EUS-FNA over EUS alone in the diagnosis of pancreatic cysts, and (3) diagnostic sensitivity and specificity of EUS and EUS-FNA in the subset of patients where histopathology of surgical specimens were available. All patients who underwent EUS examination for the evaluation of pancreatic cystic lesions in six Asian centres were included in the study. Of 298 patients with pancreatic cysts who underwent EUS, 132 (44.3 %) underwent FNA. In the entire cohort, pseudocysts and intraductal papillary mucinous neoplasm (IPMN) were the predominant cystic lesions. The cytologic yield of EUS-FNA was 47 %. On univariate analysis, factors associated with higher cytologic yield included vascular involvement on EUS, presence of solid cystic component, and increased number of needle passes during EUS-FNA. On multivariate analysis, presence of solid cystic components and increased number of needle passes during EUS-FNA were associated with higher diagnostic yield of EUS-FNA. For pancreatic cysts with a solid component, the diagnostic yield of EUS-FNA increased significantly from 44 % with one pass to 78 % with more than one pass (p = 0.016). In the absence of a solid component, the diagnostic yield was 29 % with one pass and was not significantly different from the diagnostic yield of 50 % with more than one pass, p = 0.081. The cytologic yield of EUS-FNA was 47 %. When a solid component was present in the cyst, doing more than one pass during EUS-FNA increased its diagnostic yield.

Sa1497 Prospective Double Blinded Comparison of the Diagnostic Yield of Endoscopic Ultrasonography vs Secretin Enhanced Cholangio-MRI in the Etiological Study of Idiopathic Acute Pancreatitis

Double blinded comparison of the diagnostic yield of endoscopic ultrasonography (EUS) and Secretin enhanced Cholangio-MRI (S-CMRI) in patients with idiopathic acute pancreatitis (IAP) has never been published.

Su1375 Relationship of Pancreatic Mass Size and Diagnostic Yield of Endoscopic Ultrasound Guided Fine Needle Aspiration

Su1375 Relationship of Pancreatic Mass Size and Diagnostic Yield of Endoscopic Ultrasound Guided Fine Needle Aspiration

Prospective Comparison of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in the Etiological Diagnosis of "Idiopathic" Acute Pancreatitis

The objectives of the study were to compare endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in the etiological diagnosis of patients initially diagnosed with idiopathic acute pancreatitis and to determine the clinical and analytical factors related to the end result of these techniques. Forty-nine patients, initially diagnosed with idiopathic acute pancreatitis, were evaluated prospectively with EUS and MRCP. Diagnoses were compared between the 2 procedures. The clinical-evolutionary characteristics of these patients with regard to the results obtained with these techniques were compared. In twenty-eight patients (57%), EUS and/or MRCP diagnosed at least 1 possible cause of acute pancreatitis. The diagnostic yield of EUS was higher than that of MRCP (51% vs 20%; P = 0.001). Cholelithiasis and biliary sludge (24%) were the most frequent EUS diagnoses, and pancreas divisum (8%) was the most frequent MRCP diagnosis. Only in 3 cases (6%) did MRCP identify additional features in patients etiologically undiagnosed using EUS. The EUS yield was lower in patients who had a previous cholecystectomy (11% vs 60%; P = 0.008). Endoscopic ultrasonography and MRCP are useful techniques in the etiological diagnosis of acute pancreatitis of nonestablished cause. Endoscopic ultrasonography should be preferred for establishing a possible biliary etiology in patients who have not had a cholecystectomy.

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

To evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management. This is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopy- laparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results. Forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%). Endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.

T1503: The Diagnostic Yield of EUS in the Setting of Biliary Dilatation and/or Abnormal Liver Enzymes Without an Obstructing or Mass Lesion on Conventional Radiology

Dilatation of the biliary tree on abdominal ultrasound, either alone or in the presence of abnormal liver enzymes is common, resulting in further investigations including serology, Abdominal CT and MRI. If conventional radiology is negative they are increasingly referred for Endoscopic Ultrasound (EUS) to exclude pancreatic or biliary pathology. Little data exists concerning the outcome of EUS in this cohort.

Diagnostic yield and reliability of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

Objectives. To evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with idiopathic acute pancreatitis (IAP), find factors predictive of a positive EUS finding in these patients and investigate whether these etiological findings are maintained during follow-up. Material and methods. We performed EUS in patients with IAP between July 2004 and August 2007. We recorded epidemiological data, the number and severity of previous bouts of pancreatitis and gallbladder status. Results. A total of 44 patients were included in the study. EUS was normal in seven patients (16%). In the remaining 37 patients (84%) we found cholelithiasis (n = 3), microlithiasis (n = 20), chronic pancreatitis (n = 14), pancreas divisum (n = 3), pancreatic mass (n = 1), apudoma (n = 1), cystic tumor of the pancreas (n = 2) and choledocholithiasis (n = 2). Positive EUS findings were not influenced by sex, severity of pancreatitis or recurrent disease. Patients aged < 65 years (age > or < 65 years: 73.9% versus 95.2%; P = 0.097) and patients with gallbladder in situ (cholecystectomy versus non-cholecystectomy: 63.6% versus 90.9%; P = 0.054) showed a tendency to have positive EUS findings. Mean follow-up was 28.95 ± 10.86 months (range 12–64 months; median 28 months). During follow-up the etiological diagnosis was changed in two patients, lowering the diagnostic yield to 79%. Conclusions. EUS identified the cause of IAP in 79% of patients. Patients with gallbladder in situ and patients aged < 65 years showed a tendency to have positive EUS findings. The majority of the diagnoses provided by EUS are maintained during follow-up and seem to be reliable.

Endoscopic Ultrasound in the Evaluation of Patients with Chronic Abdominal Pain

Purpose: The diagnostic evaluation of chronic abdominal pain can be difficult. The role of endoscopic ultrasound (EUS) in the work-up of chronic abdominal pain has not been defined. The purpose of this study is to determine the diagnostic yield of EUS in unexplained, chronic abdominal pain. Methods: Retrospective study of veteran patients referred for EUS for evaluation of chronic abdominal pain over a two year period. Patients were included if they had pain or discomfort within the upper abdomen for at least 6 months, did not respond to a 4-week trial of a proton pump inhibitor, and had negative work-up including computer tomography (CT) within 1 year prior to EUS. All patients underwent esophagogastroduodenoscopy (EGD) immediately prior to EUS examination during the same procedure using the Olympus GIF-H180 upper endoscope. EUS was performed using the Olympus GF-UE160 radial echoendoscope at a frequency of 7.5 MHz. A diagnosis of chronic pancreatitis was made when ≥ 5 EUS features were present. Statistical analysis was performed using the student's t-test and univariate analysis. Results: Seventeen patients (15 men, mean age 53.7 yrs) were included. Mean duration of abdominal pain was 79.3 months. EGD performed immediately prior to EUS showed no evidence of peptic ulcer disease, esophagitis or cancer. Two patients had significant extrinsic compression of the stomach on EGD. EUS showed evidence of chronic pancreatitis in 5 patients (29.4%). Two patients had extrinsic compression of the stomach caused by a markedly enlarged spleen (n=1), and an enlarged left lobe of the liver (n=1). One patient had cholelithiasis not seen on prior CT scan. Three patients had EUS findings that did not meet criteria for chronic pancreatitis. Two patients had benign appearing mediastinal lymphadenopathy. Four patients had no abnormalities on EUS. The overall diagnostic yield of EUS was 47% (8/17). When comparing patients with EUS evidence of chronic pancreatitis (5/17) to those without chronic pancreatitis (12/17), patients with chronic pancreatitis were more likely to be African American (p=0.002), have epigastric abdominal pain (p=0.037), and have weight loss (p=0.027). Patients without chronic pancreatitis were more likely to have a psychiatric illness (p=0.029). There was no significant difference among the two groups in age, alcohol use, tobacco use, duration of pain, history of diabetes, amylase, lipase, and liver function tests. Conclusion: EUS is useful in the work-up of unexplained, chronic abdominal pain. The diagnostic yield of EUS was 47% in our veteran population. EUS should be considered early in the diagnostic evaluation of select patients with chronic abdominal pain.