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Is Endoscopic Ultrasound Necessary Despite A Normal ERCP?

Posted on Mon, 18 Jul 2016

Question: So I just learned after my ERCP (looking for billary stricture) that my doc is referring me to have an EUS done. I am freaking out. The ERCP showed nothing, but he was wants to see if there is any growth within my pancreas. I am freaking out because all of my scans came back fine of my pancreas. My CA9-19 came back normal too. Could this mean I have cancer?He wants to see if there is growth within my pancreas that could be causing the stricture.

Answered by Dr. Deepak Sundriyal (4 hours later)

Brief Answer:
Hello dear. Go ahead with the EUS

Detailed Answer:
Hello dear. I have gone through the details . Your doc must have something in mind before he referred you for EUS. However if you are asymptomatic, with no loss of weight or pain abdomen and with a normal ERCP, CT scan and normal CA 19.9, it is difficult to believe you are having something in the pancreas.
However i will still advise you to go ahead with the EUS as there must have been some suspicion which needs to be ruled out.
Thanks and regards

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Deepak Sundriyal (55 minutes later)

I have been having dull abdominal pain, burping, and gall bladder symptoms. My MRCP /MRi did not show any masses. My complete blood count came back normal.

Answered by Dr. Deepak Sundriyal (2 hours later)

Brief Answer:
Hello. Nothing to worry if MRI is normal.

Detailed Answer:
Hello dear. The symptoms which you described are non specific except for the pain. They may be due to acid peptic disorders, mild gastrointestinal infections. If MRI is normal, there is nothing to worry.
Thanks and regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Deepak Sundriyal (1 hour later)

So you think the MRi/MRCP would had seen some type of mass, lesion,etc?

Answered by Dr. Deepak Sundriyal (8 minutes later)

Brief Answer:
Hello. Yes it is a good investigation

Detailed Answer:
Hello dear. Yes MRI/MRCP is a good modality and can pick up lesions. However CECT for pancreas is a equally good investigation. Moreover, as MRCP has already been done, EUS will be a good modality if MRI is unable to pick the lesion.
Thanks and regards

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Deepak Sundriyal (17 minutes later)

Should I be worried that the EUS would likely find something being I had an mri/mrcp?I know you advised not to worry.

Answered by Dr. Deepak Sundriyal (4 minutes later)

Brief Answer:
Please do not worry.

Detailed Answer:
Hello again. See, CA 19.9 is normal, MRCP is normal. It is very unlikely that something will be picked, however you cant be sure in medical science.
So you have more reasons to celebrate that nothing will be there but cannot guarantee with 100 percent. It all depends on the report.
Thanks and regards

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Deepak Sundriyal (18 hours later)

Hi, I have provided some attachments. Please review them.

Answered by Dr. Deepak Sundriyal (8 hours later)

Brief Answer:
Hello dear. reports are ok.

Detailed Answer:
Hello again. I reviewed your reports. I dont find any abnormalities in them
Go ahead with EUS.
Thanks ans regards

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Deepak Sundriyal (2 hours later)

Again do you think it will likely find a tumor, amongst my other imaging.?

Answered by Dr. Deepak Sundriyal (3 minutes later)

Brief Answer:
The chances are minimal

Detailed Answer:
The chances are minimal. I am just advising you an EUS because your primary physician have something in his mind. Moreover EUS is a safe investigation and there is no harm in undergoing an EUS. Although all your reports are normal, go ahead with it and relieve your anxiety for once and all.

Thanks and regards

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Above answer was peer-reviewed by : Dr. Prasad