1st November 2003
American Society for Gastrointestinal Endoscopy - Medical Specialty Society
Summary,


GUIDELINE OBJECTIVE(S)

To review the approach to the evaluation and treatment of the patient with suspected pancreaticobiliary malignancy

TARGET POPULATION

Patients with suspected pancreaticobiliary malignancy

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis/Evaluation

1. Serum bilirubin
2. Serum alkaline phosphatase
3. Complete physical examination
4. Serum tumor markers (i.e., CA 19-9 and carcinoembryonic antigen [CEA])
5. Chest x-ray
6. Transabdominal ultrasonography (TUS)
7. Helical computed tomography (CT) scan
8. Endoscopic ultrasound (EUS)
9. Endoscopic retrograde cholangiopancreatography (ERCP)
10. Magnetic resonance cholangiopancreatography (MRCP)
11. Fine-needle aspiration (FNA) tissue sampling
12. Biopsy
13. Magnetic resonance imaging (MRI) including MRI, MR cholangiopancreatography (MRCP), or MR angiography
14. Percutaneous transhepatic cholangiography (PTC)
15. Intraductal ultrasonography (IDUS)

Management

1. Pancreaticoduodenectomy
2. Surgical resection
3. Nonoperative palliation of obstructive jaundice
4. Chemotherapy and/or radiation therapy
5. PTC with stent placement
6. Endoscopic palliation

MAJOR OUTCOMES CONSIDERED

• Signs and symptoms
• Sensitivity and specificity of diagnostic tests