KUMJ | VOL. 23 | NO. 4 | ISSUE 92 | OCTOBER-DECEMBER

Clinico-demographic Profile and Diagnostic Modalities in Patients with Pancreatobiliary Malignancy Undergoing Endoscopic Retrograde Cholangiopancreatography in a Tertiary Care Center of Nepal
Gurung RB, Sharma P, Sapkota P, Katila S, Adhikari S, Chaudhary A

Abstract:
Background Pancreatobiliary malignancies (PBM) are often diagnosed at an advanced stage, leading to poor outcomes. Studies on the clinical profile and diagnostic efficacy in research limited settings like Nepal are scarce. Objective To describe the clinico-demographic profile characteristic and evaluate the diagnostic yield of endoscopic techniques in-patient with suspected pancreatobiliary malignancy undergoing Endoscopic Retrograde Cholangiopancreatography. Method A retrospective, cross-sectional study was conducted at the endoscopy unit of a tertiary care center of Nepal from January 2017 to January 2023. We included 597 Patients over 18 years of age with suspected pancreatobiliary malignancy who underwent endoscopic retrograde cholangiopancreatography. Data on demographics, clinical presentation and diagnostic results (brush cytology and intraductal biopsy) were analyzed using descriptive statistics. Result Among 597 patients, the majority of patients (70.1%, n=419) were aged 50 years or older, with the highest proportion found in the 60-69 year age group. Significant cases were from the hilly region (52.9%) and Brahmin/Chhetri ethnic group (35.51%). In this study 52.4% were male and the most common presenting symptoms were obstructive jaundice (42.4%), abdominal pain (37.7%), and pruritus (22.8%). Endoscopic retrograde cholangiopancreatography was technically successful for biliary drainage in 93.6% (559/597), primarily using plastic stent (77.4%). Endoscopic retrograde cholangiopancreatography guided tissue diagnosis was done in 57.1% of patients (n=341) to establish histological diagnosis. The most frequent Endoscopic retrograde cholangiopancreatography finding was a distal common bile duct stricture (52.8%). Conclusion The diagnostic yield of Endoscopic retrograde cholangiopancreatography -guided tissue sampling remains suboptimal with biopsy proving superior to cytology. In a resource-constrained setting like Nepal, while considering the cost-effective and most sensitive diagnostic tool for pancreatobiliary malignancy, the preferred sequence for diagnostic tools is sonography, followed by CT scan for initial triage, and then Endoscopic retrograde cholangiopancreatography with brush and/or biopsy with drainage.
Keyword : Bile duct, Cholangiocarcinoma, Endoscopic retrograde cholangiopancreatography, Nepal, Pancreatic neoplasm