Background and Aim: Few studies compared endoscopic ultrasound (EUS)‐guided fine needle aspiration (EUS‐FNA) with endoscopic retrograde cholangiopancreatography (ERCP)‐based tissue sampling in terms of diagnostic accuracy in suspected malignant biliary obstruction. We evaluated and compared the diagnostic performance of EUS‐FNA and ERCP‐based tissue sampling.Methods: This multicenter study included 263 patients with suspected malignant biliary obstruction who underwent same‐session EUS and ERCP between 2012 and 2016.Results: Malignancies were confirmed in 239 patients (90.9%) and benign in 24 patients (9.1%). Overall diagnostic sensitivity and accuracy were 73.6% and 76.1% for EUS‐FNA, 56.5% and 60.5% for ERCP, and 85.8% and 87.1% for EUS/ERCP combination. EUS‐FNA showed higher overall performances compared with ERCP (P < 0.001), whereas EUS/ERCP combination was superior to EUS‐FNA alone (P‐value < 0.001). EUS‐FNA showed higher sensitivity and accuracy compared with ERCP for pancreatic masses (n = 187, both P‐values < 0.001) but not for biliary lesions (n = 76, both P‐values = 0.847). Sensitivity and accuracy of EUS/ERCP combination were superior to those of EUS‐FNA for both pancreatic and biliary lesions (both P‐values < 0.001). For patients with large mass (≥ 4 cm), there was no significant differences between ERCP/EUS combination and EUS‐FNA (P‐value = 0.31).Conclusions: Same‐session EUS‐FNA and ERCP combination was superior to EUS‐FNA for both pancreatic masses and biliary lesions. Same‐session EUS/ERCP combination can be considered a proper diagnostic method for suspected malignant biliary obstruction regardless of the origin of lesions. On the other hand, EUS‐FNA alone was sufficient for diagnosis compared with EUS/ERCP combination in cases with large mass. Strategic diagnostic approach, according to clinical features of individual patient, is required.

Life expectancy of pancreatic ductal adenocarcinoma (PDAC) patients is usually short and selection of the most appropriate treatment is crucial. The aim of this study was to investigate the usefulness of serum CA 19-9 as a surrogate marker under no impress excluding other factors affecting CA 19-9 level other than tumor itself. We recruited 1,446 patients with PDACs and patients with Lewis antigen both negative or obstructive jaundice were excluded to eliminate the false effects on CA 19-9 level. The clinicopathologic factors were reviewed including initial and post-treatment CA 19-9, and statistical analysis was done to evaluate the association of clinicopathologic factors with overall survival (OS). The total of 944 patients was enrolled, and205 patients (22%) underwent operation with curative intention and 541 patients (57%) received chemotherapy and/or radiotherapy. The median CA 19-9 levels of initial and post-treatment were 670 IU/ml and 147 IU/ml respectively. The prognostic factors affecting OS were performance status, AJCC stage and post-treatment CA 19-9 level in multivariate analysis. Subgroup analysis was done for the patients who underwent R0 and R1 resection, and patients with normalized post-operative CA 19-9 (≤37 IU/mL) had significantly longer OS and DFS regardless of initial CA 19-9 level; 32 vs. 18 months, P<0.001, 16 vs. 9 months, P = 0.004 respectively. Post-treatment CA 19-9 and normalized post-operative CA 19-9 (R0 and R1 resected tumors) were independent factors associated with OS and DFS, however, initial CA 19-9 level was not statistically significant in multivariate analysis.

Paik WH, et al. J Korean Med Sci. 2013 May;28(5):750-754. http://dx.doi.org/10.3346/jkms.2013.28.5.750