All 9 patients had undergone prior magnetic resonance imaging (MRI) and MRCP. MRCP was abnormal in 6 patients, revealing extrahepatic and intrahepatic ductal dilation suggestive of a biliary stricture (patients 1, 2, and 7) or pancreatitis (patients 4, 6, and 8). EUS confirmed the findings in all these patients. In 3 patients with no abnormalities

seen on MRI/MRCP, EUS accurately detected characteristics features of AIP (patient 9) or was without significant abnormalities (patients 3 and 5). A median of 2 TCB passes (range, 1-3) were obtained that retrieved an average of 8.9 mm of tissue per pass (range, 0-18 mm) as reported by the pathologist. We relied on the more accurate cytopathologist measurement and not the endosonographer find more measurement because of the tendency to overestimate the specimen length in freshly obtained nonprocessed tissue. Specimens were obtained from the pancreatic neck (n = 3, 19%), body (n = 10, 62%), and tail (n = 3, 19%). EUS TCB was diagnostic (n = 5) or partially diagnostic (n = 1) in 6 of 7 patients (86%) with pancreatic pathology (Fig. 1,Table 2). Patient 9, who had a nondiagnostic TCB, was ultimately diagnosed

with AIP. In this patient, after 2 hypocellular FNA samples were obtained without evidence of obtaining a core tissue, TCB was then performed. Additional TCB passes were not attempted due to the development of self-limited bleeding occurring with each FNA and TCB pass. In the remaining 2 patients followed for 1 to 2 months, a final diagnosis of idiopathic nonpancreatic abdominal pain was established given the continued absence of apparent

pancreatic pathology on subsequent imaging GSK458 clinical trial and laboratory evaluation. In these 2 latter patients, TCB revealed benign pancreatic tissue (patient 3) and fibrofatty tissue (patient 5). Both patients had subtle nonspecific changes seen on EUS and a normal MRI/MRCP. Despite the lack of significant pancreatic abnormalities on imaging, we carefully considered and decided to perform TCB given the potential for identifying pathology that could impact the management of these patients with prolonged symptoms that significantly impacted Fenbendazole their quality of life. We regard the TCB obtained in patient 5 as inadequate given the lack of pancreatic tissue within the specimen. Most of the procedures (67%) were performed in an outpatient setting. The 3 patients who underwent an inpatient EUS (patients 1, 3, and 5) had prearranged 24-hour observation scheduled before EUS. Patient 1 was discharged within 24 hours without developing any symptoms. Patients 3 and 5 remained hospitalized for 5 and 2 days, respectively, for pain management. Both patients had chronic abdominal pain that was not altered in character or severity after EUS. Their pain and hospitalizations were not thought to be related to the interventions performed but instead attributed to their underlying disorder (Table 3).