OR-LUM-07: Feasibility of a complete pancreaticobiliary linear endoscopic ultrasound examination from the stomach

BACKGROUND: Linear endoscopic ultrasound (EUS) evaluation of pancreaticobiliary (PB) system usually requires scanning from both stomach and duodenum. Feasibility of assessing the complete PB system from stomach alone has not been studied. OBJECTIVES: To conceptualize and evaluate a system-based approach (railroad approach) for linear PB-EUS, by which the PB anatomy could be assessed from the stomach itself. METHODS: Three maneuvers were conceptualized and evaluated (alpha maneuver for stomach and sigma and xi maneuvers for duodenum). The maneuvers were prospectively evaluated in 100 consecutive patients requiring PB-EUS. RESULTS: The three maneuvers could be completed in a median time of 12 min (range 8–22 min). Median total procedure time was significantly higher than that for alpha maneuver alone (12 vs. 6 min, P = 0.0001). The visualization rates of hilum and common hepatic duct (100% vs. 83.5%, P = 0.0001) were significantly higher from the stomach than from the duodenum. The visualization rates of retropancreatic common bile duct (CBD) (97.6% vs. 100%, P = 0.49), uncinate process (100% vs. 100%), and pancreatic duct (98.8% vs. 100%, P = 1.0) did not differ significantly if patients with pancreatic head calcifications were excluded. There was no significant difference in the clinical diagnosis made from the stomach versus that made from the duodenum, after excluding body and tail lesions (head of the pancreas neoplasms 100% vs. 100%, CBD stone 100% vs. 84.6% [P = 0.75], pancreatic cysts 83.3% vs. 83.3%, respectively). CONCLUSIONS: Adequate anatomical and diagnostic information of the PB system may be acquired by EUS scanning from the stomach in significantly shorter procedure time.