Endoscopy 2018; 50(01): 22-32
DOI: 10.1055/s-0043-118592
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility of a complete pancreatobiliary linear endoscopic ultrasound examination from the stomach

Vinay Dhir
1  Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
Douglas G. Adler
2  University of Utah School of Medicine, Salt Lake City, Utah, USA
Nonthalee Pausawasdi
3  Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
Amit Maydeo
1  Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
Khek Yu Ho
4  National University Health System, Singapore
› Author Affiliations
Further Information

Publication History

submitted 08 March 2017

accepted after revision 17 July 2017

Publication Date:
21 September 2017 (eFirst)


Background and study aims Linear endoscopic ultrasound (EUS) evaluation of the pancreaticobiliary system usually requires scanning from both the stomach and the duodenum. The feasibility of assessing the complete pancreaticobiliary system from the stomach alone has not been studied. We aimed to conceptualize a system-based approach (the railroad approach) for linear pancreaticobiliary EUS (PB-EUS) and evaluate whether the pancreaticobiliary anatomy could be assessed from the stomach alone.

Patients and methods Three maneuvers were conceptualized and evaluated (the alpha maneuver in the stomach, and sigma and xi maneuvers in the duodenum). The maneuvers were prospectively evaluated in 100 consecutive patients requiring PB-EUS. 

Results The median procedure time for the three maneuvers was significantly higher than that for the alpha maneuver alone (12 vs. 6 minutes; P ≤ 0.001). The visualization rate of the hilum and common hepatic duct was significantly higher from the stomach than from the duodenum (100 % vs. 83.5 %; P ≤ 0.001), while rates for the head of the pancreas (100 % vs 100 %) and uncinate process (100 % vs 100 %) did not differ. The suprapancreatic common bile duct (CBD; 92 % vs 100 %; P = 0.006), retropancreatic CBD (95 % vs 100 %; P = 0.06), and pancreatic duct in the head (94 % vs 100 %; P = 0.03) were not completely visualized from the stomach, because of pancreatic calcification or shadow from the ligaments. The EUS diagnosis made from the stomach and duodenum did not differ after excluding body and tail lesions (pancreatic head neoplasms, 100 % vs 100 %; CBD stone, 100 % vs 84.6 %; pancreatic cysts in the head, 83.3 % vs 83.3 %, respectively).

Conclusions Adequate anatomical and diagnostic information on the pancreaticobiliary system may be acquired by EUS scanning from the stomach alone and with a shorter procedure time.