Su1678 ERCP With Ampullary Biopsy Versus ERCP Alone, a Matched Case-Control Evaluation of Post ERCP Complications and Post-ERCP Pancreatitis

Figure 1. The pooled sensitivity of routine cytology (A) and FISH (B) for detection of malignant strictures was 0.36 (95% CI, 0.32-0.40) and 0.62 (95% CI, 0.58-0.66), respectively. Figure 2. The pooled specificity of routine cytology (A) and FISH (B) was 0.97 (95% CI, 0.96-0.98) and 0.82 (95% CI, 0.79-0.84), respectively Su1678 ERCP With Ampullary Biopsy Versus ERCP Alone, a Matched CaseControl Evaluation of Post ERCP Complications and Post-ERCP Pancreatitis Jai Eun Lee*, Jennifer a. Luke, Sunil Dacha, Field F. Willingham, Saurabh Chawla Digestive Diseases, Emory University School of Medicine, Atlanta, GA; Internal Medicine, Emory University School of Medicine, Atlanta, GA Background: Biopsy of the ampulla of Vater is performed for evaluation of suspected ampullary tumors, immunohistological staining for autoimmune pancreatitis and occasionally for further assessment of an incidentally noted abnormal ampullary appearance. Most ampullary biopsies are performed at the time of endoscopic retrograde cholangiopancreatography (ERCP). ERCP itself carries a 5-10% risk of pancreatitis in most series. Complications following ampullary biopsy www.giejournal.org Vol have not been systematically examined and in the context of post-ERCP complications, the contribution of ampullary biopsy as a potential independent risk factor has not been investigated. Objective: To evaluate if ampullary biopsies performed at the time of ERCP (ERCPwAB) increased complications compared to a matched group of patients undergoing ERCP without ampullary biopsies (ERCP) and examine the diagnostic yield of ampullary biopsies obtained at ERCP. Methods: Casecontrolled, retrospective review of adult patients undergoing ampullary biopsies during ERCP (ERCPwAB) compared to a matched control group undergoing ERCP without ampullary biopsies (ERCP) by procedure complexity (ASGE grade) at a tertiary care center. Data collection included patient demographics, procedure indications, endoscopic findings, post procedure complications, and final pathologic diagnosis for ampullary biopsy. Patients undergoing endoscopic ampullectomy were excluded. Results: 54 ERCPwAB procedures were compared with 54 ERCP procedures. All procedures were performed with adult therapeutic duodenoscopes (Olympus TJF Q 180V, Q 160) and biopsies obtained using standard endoscopic forceps (2.4 mm OD). Ampullary biopsies had a good diagnostic yield and suggested a diagnosis in 76% of the procedures (Table 1). The overall rate of complications in ERCPwAB group (5/54, 9.26%) did not differ from the rate of complications with ERCP alone in the control group (5/54, 9.26%, pZ 0.9). The incidence of postprocedure pancreatitis also was not significantly different between the groups (3/54 ERCP wAB vs 2/54 ERCP, pZ 0.6). Conclusions: Ampullary biopsy performed during ERCP for an ampullary mass lesion or an abnormal ampullary appearance has a diagnostic yield of 76% and is not associated with increased post procedure complications or post-procedure pancreatitis when compared to matched ERCPs performed without ampullary biopsy.