Combined Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in Patients With Malignant Distal Biliary Obstruction Is Associated With Reduced Time to Oncological Therapy Compared With ERCP and Sampling Alone.

Abstract

Objectives: Standard endoscopic retrograde cholangiopancreatography (ERCP) sampling techniques for pancreaticobiliary malignancy have modest yields that could lead to delays in treatment. We evaluated whether combining EUS-guided tissue acquisition (EUS-TA) with ERCP improved time to first outpatient evaluation and treatment.

Materials and methods: All patients without a prior pathological diagnosis who underwent index ERCP at Leeds Teaching Hospitals NHS Trust, United Kingdom, for malignant distal biliary obstruction from 2015 to 2020 were considered.

Results: A total of 292 patients were included, of whom 74.7% (n = 202) underwent EUS-TA/ERCP. A combined approach was more likely to establish a positive diagnosis (96.5% [n = 195] vs 57.8% [n = 52], P < 0.01) and less likely to require further sampling procedures (2.0% [n = 4] vs 17.8% [n = 16], P < 0.01). Mean times to first outpatient evaluation (16.9 vs 24.5 days [ P = 0.01]) and oncological treatment (55.1 vs 79.3 days [ P = 0.03]) were significantly shorter. A third (n = 86) of patients with a positive diagnosis did not receive oncological/surgical treatment.

Conclusions: A combined approach was associated with improved yield and reduced time to evaluation/treatment, with similar success and adverse event rates. Careful multidisciplinary discussion is recommended to avoid performing unnecessary EUS procedures.