Volume 3, Issue 6, November 2015, Page: 217-223
Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology
Taha Ahmed Mohmmad Al-karboly, Faculty of Medicine, University of Sulaimani, Iraqi Kurdistan, Iraq
Received: Sep. 4, 2015;       Accepted: Sep. 19, 2015;       Published: Oct. 15, 2015
DOI: 10.11648/j.ajim.20150306.11      View  3143      Downloads  77
Abstract
Background: Pancreatobiliarydiseases (PBD) comprises diseases of both biliary system and pancreas and their diagnosis depends on appropriate clinical evaluation and investigations including imaging modalities like transabdominal ultrasound (TAUS), Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT); Endoscopic ultrasound(EUS) have been found to be more sensitive than other imaging modality for detecting PBD, and less invasive than endoscopic retrograde cholangiopancreatography (ERCP). Aim of study: To compare the sensitivity and specificity of EUS with other imaging studies like ERCP, TAUS, CT scan, and MRCP/MRI for diagnosing PBD. Patients & Methods: This study conducted in Kurdistan Centre for Gastroenterology and Hepatology (KCGH) from December 2013 through December 2014, after approval of institutional board ethical committee and taking written informed consents from all patients. A total number of 100 patients were enrolled in the study. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EUS, MRCP, and TAUS for PBD (benign & malignant). ERCP was used as a reference standard for comparison. Results: 60% were females and 40% were males; the main presenting symptoms were combined abdominal pain and obstructive jaundice. The sensitivity, specificity, PPV, NPV, and accuracy of EUS for detecting benign biliary diseases like (bile duct stone and its complications) were 96.1%, 65.2%, 86%, 83.3%, and 89%, respectively; and for detecting pancreatobiliary tumors (PBT) were 84.6%, 97.7%, 84.6%, 97.7%, and 96%, respectively. The sensitivity of TAUS, MRCP for diagnosing biliary diseases were 58%, and 60%, respectively; and their sensitivity for detecting PBT were 37.5%, and 50%, respectively. The comparison between CT scan and ERCP was not feasible statistically. Conclusion: EUS has a higher sensitivity in comparison to other imaging modalities in detecting PBD; we can depend on it in selecting patients for therapeutic ERCP, in order to avoid unnecessary ERCP and its complications. The sensitivity and specificity of EUS in KCGH is comparable to other studies elsewhere.
Keywords
PBD, EUS, ERCP, MRCP, KCGH (Kurdistan Centre for Gastroenterology & Hepatology), Sulaimani
To cite this article
Taha Ahmed Mohmmad Al-karboly, Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology & Hepatology, American Journal of Internal Medicine. Vol. 3, No. 6, 2015, pp. 217-223. doi: 10.11648/j.ajim.20150306.11
Reference
[1]
David Q.-H. Wang, Nezam H. Afdhal. Gallstone Disease. In: Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt editors. 10th ed. Philadelphia. Elsevier Saunders; 2015. Sleisenger and Fordtran’s Gastrointestinal and Liver disease. P 1100-1133.
[2]
Laurent Palazzo, Anne Marie Lennon, Ian Penman. Endosonography. In: Jean Marc Canard, Jean-Christophe Létard, Laurent Palazzo, Ian Penman, Anne Marie Lennon editors. 1st ed. Edinburgh. Elsevier Churchill Livingstone; 2011. Gastrointestinal Endoscopy in Practice. P 274-369.
[3]
Einstein D, Lapin S, Ralls P, et al. The insensitivity of sonography in the detection of choledocholithiasis. Am J Roentgenol 1984; 142:725-8.
[4]
Barkun A, Barkun J, Fried G, et al. Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg 1994; 220:32-9.
[5]
Caoili E, Paulson E, Heyneman L, et al. Helical CT cholangiography with three-dimensional volume rendering using an oral biliary contrast agent: Feasibility of a novel technique. Am J Roentgenol 2000; 174:487-92.
[6]
Bortoff G, Chen M, Ott D, et al. Gallbladder stones: Imaging and intervention. Radiographics 2000; 20:751-66.
[7]
Crabtree TD, Yacoub WN, Puri V, et al. Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. Ann Thorac Surg. 2011;91(5):1509-1515.
[8]
John Meenan, Charles Vu. Equipment. In: Robert H. Hawes, Paul Fockens, Shyam Varadarajulu editors. 3rd ed. Philadelphia. Elsevier Saunders; 2015. Endosonography. P 16-25.
[9]
Faris M. Murad, Mark Topazian. Indications, Preparation, and Adverse Effects. In: Robert H. Hawes, Paul Fockens, Shyam Varadarajulu editors. 3rd ed. Philadelphia. Elsevier Saunders; 2015. Endosonography. P 35-45.
[10]
Michaels AJ, Draganov PV. Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis. World J Gastroenterol. 2007;13(26):3575-80.
[11]
Barish MA, Yucel EK, Ferrucci JT. Magnetic resonance cholangiopancreatography. N Engl J Med 1999; 341:258.
[12]
Turowska A, Łebkowska U, Kubas B, et al. The role of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis and assessment of resectability of pancreatic tumors. Med Sci Monit. 2007 May;13 Suppl 1:90-7.
[13]
Bowie JD. Am J Gastroenterol. 2000 Apr;95(4):897-900.
[14]
Niederau C, Sonnenberg A, Mueller J. Comparison of the extrahepatic bile duct size measured by ultrasound and by different radiographic methods. Gastroenterology. 1984 Sep;87(3):615-21.
[15]
Ching-Ruei Hung, Ay-Chiao Huang, Yen-Chen Chen, et al. Common Bile Duct Diameter Measurement by Magnetic sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb; 56(1): 45–50.
[16]
Rajul Parikh, Annie Mathai, Shefali Parikh, et al. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb;
[17]
Yonetci N, Kutluana U, Yilmaz M, et al. The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2008; 7:520-4.
[18]
Giuseppe Garcea, Wee Ngu, Christopher P. Neal, et al. Bilirubin levels predict malignancy in patients with obstructive jaundice. International Hepato- Pancreato-Biliary Association 2011; 13:426–430.
[19]
Varayu Prachayakul, Pitulak Aswakul, Patommatat Bhunthumkomol,et al. Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center. BMC Gastroenterology 2014; 14:165.
[20]
H E Adamek, J Albert, M Weitz, et al. A prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected bile duct obsruction. Gut 1998;43:680–683.
[21]
De Lédinghen V, Lecesne R, Raymond JM, et al. Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 1999; 49:26-31.
[22]
Chak A, Hawes R, Cooper G, et al. Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis. Gastrointest Endosc 1999; 49:599 -604.
[23]
Frossard JL, Hadengue A, Amouyal G,et al: Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc 2000, 51:175–179.
[24]
Jean Marc Canard, Anne Marie Lennon, Jean-Christophe Létard et al. Endoscopic retrograde cholangiopancreatography. In: Jean Marc Canard, Jean- Christophe Létard, Laurent Palazzo, Ian Penman editors. Edinburgh. Elsevier Churchill livingstone; 2011. Gastrointestinal endoscopy in practice. P 370-465.
[25]
Chen CH, Tseng LJ, Yang CC, et al. Preoperative evaluation of periampullary tumors by endoscopic sonography, transabdominal sonography, and computed tomography. J Clin Ultrasound.2001;29:313–21.
[26]
Britt-Marie Karlson, Anders Ekbom, Per Gunnar Lindgren, et al. Abdominal US for Diagnosis of Pancreatic Tumor: Prospective Cohort Analysis. Radiology 1999; 213:107-111.
[27]
Verma SR, Sahai SB, Gupta PK, et al. Obstructive Jaundice- Aetiological Spectrum, Clinical, Biochemical And Radiological Evaluation At A Tertiary Care Teaching Hospital The Internet Journal of Tropical Medicine 2011; 7(2).
[28]
Nyree Griffin, Geoff Charles-Edwards, Lee Alexander Grant. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging (2012) 3:11–21.
[29]
Shoup M, Hodul P, Aranha GV, et al. Defining a role for endoscopic ultrasound in staging periampullary tumors. Am J Surg. 2000 Jun;179(6):453-6.
[30]
Gonzalo-Marin J, Vila JJ, Perez-Miranda M. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol. 2014;15;6(9):360- 368.
Browse journals by subject