Initial Experience with Endoscopic Ultrasound in Determining Uncertain Cases of Biliary and Pancreatic Duct Disorders

Background:

The diagnosis of biliary and pancreatic tract diseases is usually straight forward when both the clinical picture and ancillary procedures demonstrate the disease in question. However, some cases are difficult to diagnose especially when diagnostic results are obscured. Endoscopic ultrasound (EUS) is a diagnostic modality that can be utilized in identifying biliary and pancreatic tract diseases in uncertain cases.

Objective:

• To present the utility of endoscopic ultrasound in diagnosing indeterminate causes of biliary and pancreatic duct disorders

• To know if endoscopic ultrasound will alter the diagnosis and its subsequent management in this group of patients

Case Summary:

Five patients presented with epigastric pain while 1 had fever of unknown origin. All, but one who did not have laboratory tests, had normal to mildly elevated liver function tests; one had elevated serum alkaline phosphatase level. Transcutaneous ultrasound findings were: normal (2), fatty liver, gall bladder sludge or stones (2), hepatic mass. Three patients had CT scan with normal results (2) and one chronic pancreatitis. Two patients had gastroscopy (1 with normal result, 1 with erosive gastritis). Two had previous ERCPs: 1 with failed ERCP while the other slightly dilated common bile duct without filling defects.

Results:

All five patients had dilated CBD, 1 with hyperechoic sludges, 5 with small stone/s. One patient had findings consistent with chronic pancreatitis. All patients underwent post-EUS ERCP and were found to have CBD stones 3 to 5mm in size. Stone extraction was performed in all patients. Three patients eventually had cholecystectomy. All patients are asymptomatic up to present.