Diagnostic Yield Of Endoscopic Retrograde Cholangiopancreatography (ERCP) For Pancreatobiliary Diseases

Part ? Diagnostic Utility of Endoscopic Retrograde Cholangiography/Intraductal Ultrasound(ERC/IDUS)in Distinguishing Malignant from Benign Bile Duct ObstructionBackground and Aim Accurately differentiating malignant diseases from benign ones in patients having bile duct obstruction is of significant importance and remains a major clinical problem.This study investigated the diagnostic yield of endoscopic retrograde cholangiography/intraductal ultrasound(ERC/IDUS)in distinguishing malignant from benign bile duct obstruction and assessed some image findings from ERC/IDUS which might beuseful in differentiation.Methods From January 2008 to January 2015,patients who underwent ERC/IDUS for bile duct obstruction were enrolled.Patient's ERC/IDUS diagnosis was compared with the final diagnosis determined by pathologic findings and/or clinical outcome of follow-up.Results One hundred and ninety-three patients with bile duct obstruction were included.IDUS correctly identified 94 of 97 malignant diseases and 76 of 96 benign diseases with sensitivity,specificity,and accuracy rate of 96.91,79.17,and 88.08 %,respectively.Additionally,the accuracy rate of IDUS for diagnosis of proximal bile duct obstruction was higher than that of distal bile duct obstruction(98.08 vs.82.73 %,p = 0.006).Besides,there was a significant difference in the length at the obstruction site between benign and malignant diseases(13.76 ± 7.37 vs.19.97 ±11.37 mm,p\0.001)as well as thickness of bile duct wall at the site of obstruction(3.06 ± 0.92 vs.7.03 ± 3.70 mm,p = 0.008).Biliary wall thickness[7 mm without extrinsic compression had a positive predictive value(PPV)of 100 % for including malignancy,while length ]20 mm demonstrated a PPV of 93.44 %.Conclusions ERC/IDUS is effective in distinguishing malignant from benign bile duct obstruction,thus helping in further clinical management.Part ? Influence of Periampullary Diverticulum On the Occurrence of Pancreaticobiliary Diseases And Outcomes of Endoscopic Retrograde CholangiopancreatographyBackground and aim Periampullary diverticulum(PAD)is frequently encountered in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).The aim of this study was to investigate the association of PAD with pancreaticobiliary diseases as well as the impact of PAD on the technical success of ERCP and different methods of bile duct stone extraction.Patients and methods A total of 1489 cases of patients with PAD were identified from 6390 patients who underwent ERCP.These patients were compared with 1500 controls without PAD in terms of biliary stone formation,technical success,and complications ofERCP.Results Patients with PAD had increased prevalence of bile duct stones,gallstones,and cholangitis(P<0.01).Successful cannulation rates were similar in the PAD and the control group(98.59 vs.99.07%,P=0.225).The incidence of complications did not differ between the PAD and the control group.Successful stone removal rate of endoscopic sphincterotomy(EST)was lower in the PAD group than in the control group(83.53 vs.94.31%,P=0.005).In patients with PAD,the rate of successful stone removal was lower in the EST group than in the endoscopic papillary balloon dilation(EPBD)and EPBD combined with limited EST(ESBD)group.The rates of complications were similar among different treatments(EST,EPBD,or ESBD)in patients with PAD.Conclusion PAD is associated with bile duct stones,gallstones,and cholangitis.In addition,PAD should not be considered a barrier to a successful cannulation.Moreover,EST is less effective than EPBD and ESBD in patients with PAD,whereas EST,EPBD,and ESBD are equally safe in patients with PAD.