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The role of endoscopic ultrasonography in diagnosis staging, and management of pancreatic disease states

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Abstract

The role of endoscopic ultrasound in evaluation of pancreatic diseases is evolving. This article reviews the advantages and limitations of endoscopic ultrasound when compared with other available imaging technologies in the evaluation of chronic pancreatitis, pancreatic cancer, neuroendocrine tumors, and cystic lesions of the pancreas. New therapeutic procedures using endoscopic ultrasound in the treatment of pancreatic disease are discussed, in addition to potential future applications.

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References and Recommended Reading

  1. Tio TL, Cohen P, Coene PP, et al.: Endosonography and computed tomography of esophageal carcinoma. Gastroenterology 1989, 96:1478–1486.

    PubMed  CAS  Google Scholar 

  2. Rosch T, Lorenz R, Zenker K, et al.: Local staging and assessment of resectability in carcinoma of esophagus, stomach and duodenum by endoscopic ultrasonography. Gastrointest Endosc 1992, 38:460–467.

    PubMed  CAS  Google Scholar 

  3. Botet JF, Lightdale CJ, Zauber AG, et al.: Endoscopic ultrasonography in the preoperative staging of gastric cancer: a comparative study with dynamic CT. Radiology 1999, 181:426–432.

    Google Scholar 

  4. Rosch T, Lorenz R, Braig C, et al.: Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 1991, 37:347–352.

    Article  PubMed  CAS  Google Scholar 

  5. Boyce GA, Sivak MV, Lavery IC, et al.: Endoscopic ultrasound in the preoperative staging of rectal cancer. Gastrointest Endosc 1992, 38:468–471.

    PubMed  CAS  Google Scholar 

  6. Wiersema MJ, Hawes RH, Lehman GA, et al.: Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 1993, 25:555–564.

    PubMed  CAS  Google Scholar 

  7. Sahai AV, Zimmerman M, Aubakken L, et al.: Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 1998, 48:18–25. Report on study (N=126) of patients with abdominal pain and/or suspected chronic pancreatitis who underwent ERCP and EUS. EUS was found to have variable sensitivity and specificity for diagnosing chronic pancreatitis depending on the threshold number of abnormal EUS criteria necessary to establish the diagnosis.

    Article  PubMed  CAS  Google Scholar 

  8. Catalano MF, Lahoti S, Geenen JE, Hogan WJ: Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 1998, 48:11–17. Patients (N=80) with nonalcoholic recurrent pancreatitis were evaluated with ERCP, EUS, and secretin-based pancreatic function testing. EUS and secretin testing had excellent correlation in normal subjects and in patients with severe chronic pancreatitis but was poor in mild to moderate disease. EUS and ERCP had excellent correlation for normal subjects and moderate to severe chronic pancreatitis but was poor for mild disease.

    Article  PubMed  CAS  Google Scholar 

  9. Bhutani MS: Endoscopic ultrasonography: changes of chronic pancreatitis in asymptomatic and symptomatic alcoholic patients. J Ultrasound Med 1999, 18:455–462. EUS was performed in a series of 31 alcoholic patients with and without chronic abdominal pain. Eighty-nine percent of symptomatic and 58% of asymptomatic patients had changes suggestive of chronic pancreatitis at EUS. In a control nonalcoholic population, these abnormalities were present in 29% of symptomatic and 0% of asymptomatic patients.

    PubMed  CAS  Google Scholar 

  10. Hastier P, Buckley JM, Francois E, et al.: A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities. Gastrointest Endosc 1999, 49:705–709. Seventy-two patients with alcoholic cirrhosis and no historical evidence of chronic or recurrent pancreatitis underwent ERCP (n=71) and EUS (n=72). Chronic pancreatitis was identified by ERCP in 19% (n=14) of the patients. EUS identified abnormalities in 31 (43%) patients, 13 of whom had an abnormal ERCP. These parenchymal abnormalities did not progress on follow-up.

    Article  PubMed  CAS  Google Scholar 

  11. Yasuda K, Mukai H, Fujimoto S, et al.: The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc 1988, 34:1–8.

    PubMed  CAS  Google Scholar 

  12. Rosch T, Braig C, Gain J, et al.: Staging of pancreatic and ampullary carcinomas by endoscopic ultrasound. Gastroenterology 1992, 102:188–189.

    PubMed  CAS  Google Scholar 

  13. Palazzo L, Roseau G, Gayet B, et al.: Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma: results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 1993, 25:143–150.

    PubMed  CAS  Google Scholar 

  14. Gress FG, Hawes RH, Savides TJ, et al.: Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience. Gastrointest Endosc 1999, 50:786–791. One hundred and fifty-one patients with pancreas cancer underwent staging with axial CT and EUS. In 81 patients undergoing surgery, EUS was more accurate than CT for T (85% vs 30%) and N (72% vs 55%) staging. Unfortunately, this study was performed with axial and not dual-phase helical CT, which detracts from any conclusions regarding CT performance.

    Article  PubMed  CAS  Google Scholar 

  15. Legmann P, Vignaux O, Dousset B, et al.: Pancretic tumors: comparison of dual-phase helical CT and endoscopic sonography. Am J Roentgenol 1998, 170:1315–1322. Thirty patients underwent preoperative EUS and dual-phase helical CT. Overall accuracy for staging (90%) and determining resectability (90%) was the same for both techniques. Dual-phase helical CT and EUS do not differ significantly for diagnosis and assessment of resectability of pancreatic tumors.

    CAS  Google Scholar 

  16. Howard TJ, Chin AC, Streib EW, et al.: Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma. Am J Surg 1997, 147:237–241.

    Article  Google Scholar 

  17. Midwinter MJ, Beveridge CJ, Wilsdon JB, et al.: Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours. Br J Surg 1999, 6:189–193. In 48 patients with suspected pancreatic or ampullary tumors, sensitivity and specificity of EUS and dual-phase helical CT for detecting superior mesenteric vein, portal vein, and lymph node involvement were similar. EUS was less effective at identifying superior mesenteric artery involvement.

    Article  Google Scholar 

  18. Bender GN, Case B, Tsuchida A, et al.: Using sectorial endoluminal ultrasound to identify the normal pancreas when axial computed tomography is falsely positive. Investigative radiology 1999, 34:71–74. Sixty-five patients with suspected small pancreatic lesions on axial CT underwent EUS. In determining the presence or absence of a mass, the sensitivity and specificity, respectively, were 91% and 41% for axial CT and 88% and 88% for EUS (P <.05). EUS can be used to clarify uncertain abnormalities on CT.

    Article  PubMed  CAS  Google Scholar 

  19. Brentall TA, Bronner MP, Byrd DR, et al.: Early diagnosis and treatment of pancreatic dysplasia in pacientes with family history of pancreatic cancer. Ann Intern Med 1999, 131:247–255. Fourteen patients with a strong family history of pancreas cancer underwent EUS, ERCP, helical CT, CEA, and CA 19-9 testing. In seven patients with an abnormal ERCP, pancreatectomy was done and revealed widespread dysplasia. Ten patients had an abnormal EUS (seven with abnormal ERCP). The significance of abnormal EUS examinations in these three additional patients will require long-term follow-up.

    Google Scholar 

  20. Gress FG, Hawes RH, Savides TJ, et al.: Endoscopic ultrasoundguided fine-needle aspiration biopsy using linear array and radial scanning endosonography [see comments]. Gastrointest Endosc 1997, 45:243–250.

    Article  PubMed  CAS  Google Scholar 

  21. Wiersema MJ, Vilmann P, Giovannini M, et al.: Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997, 112:1087–1095.

    Article  PubMed  CAS  Google Scholar 

  22. Giovannini M, Seitz JF, Monges G, et al.: Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy 1995, 27:171–177.

    PubMed  CAS  Google Scholar 

  23. Cahn M, Chang K, Nguyen P, Butler J: Impact of endoscopic ultrasound with fine-needle aspiration on the surgical management of pancreatic cancer. Am J Surg 1996, 172:470–472.

    Article  PubMed  CAS  Google Scholar 

  24. Bhutani MS, Hawes RH, Baron PL, et al.: Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy 1997, 29:854–858.

    PubMed  CAS  Google Scholar 

  25. Chang KJ, Nguyen P, Erickson RA, et al.: The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997, 45:387–393.

    Article  PubMed  CAS  Google Scholar 

  26. Erickson RA: Endoscopic ultrasonography: a new diagnostic imaging modality. Am Family Physician 1997, 55:2219–28.

    CAS  Google Scholar 

  27. Faigel DO, Ginsberg GG, Bentz JS, et al.: Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. J Clin Oncol 1997, 15:1439–1443.

    PubMed  CAS  Google Scholar 

  28. Suits J, Frazee R, Erickson RS: Endoscopic ultrasound and fine needle aspiration for the evaluation of pancreatic masses. Arch Surg 1999, 134:639–643. EUS FNA had a sensitivity of 96%, specificity of 100%, and overall accuracy of 96% when evaluating 98 patients with pancreas masses or cystic lesions.

    Article  PubMed  CAS  Google Scholar 

  29. Williams DB, Sahai AV, Aabakken L, et al.: Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut 1999, 44:720–726. Sensitivity, specificity, and accuracy of EUS FNA in evaluating 144 patients with pancreatic masses were 82%, 100%, and 85%, respectively. No complications with EUS FNA were reported.

    Article  PubMed  CAS  Google Scholar 

  30. Rosch T, Lightdale CJ, Botet JF, et al.: Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 1992, 326:1721–1726.

    Article  PubMed  CAS  Google Scholar 

  31. Zimmer T, Stolzel U, Bader M, et al.: Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 1196, 39:562–568.

    Google Scholar 

  32. Proyce C, Malvaux P, Pattou F, et al.: Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery 1998, 124:1134–1144. In 34 patients with functioning neuroendocrine tumors, EUS and somatostatin receptor scintigraphy (SRS) had sensitivities of 79% versus 60% for insulinoma and 73% versus 75% for gastrinoma, respectively. SRS may be better suited as an initial diagnostic test in gastrinoma to allow for detection of metastatic disease as well as localization. EUS can be used as an adjuvant modality for diagnosing gastrinoma and as the primary diagnostic modality for insulinoma.

    Article  Google Scholar 

  33. Bansal R, Tierney W, Carpenter S, et al.: Cost effectiveness of EUS for preoperative localization of pancreatic endocrine tumros. Gastrointest Endosc 1999, 49:19–25. Initial evaluation with EUS in patients with suspected functioning neuroendocrine tumors was more cost effective than a diagnostic algorithm not employing EUS. Unfortunately, the study did not consider the role of SRS in these patients.

    Article  PubMed  CAS  Google Scholar 

  34. Koito K, Namieno T, Nagakawa N, Morita K: Solitary cystic tumors of the pancreas: EUS pathologic correlation. Gastrointest Endosc 1997, 45:268–276.

    Article  PubMed  CAS  Google Scholar 

  35. Warshaw AL, Compton CC, Lewandowski K, et al.: Cystic tumors of the pancreas: new clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990, 212:432–443.

    Article  PubMed  CAS  Google Scholar 

  36. Warshaw AL, Compton CC, Lewandrowski K, et al.: Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients [includes discussion]. Ann Surg 1990, 212:432–445.

    Article  PubMed  CAS  Google Scholar 

  37. Hammel P, Levy P, Voitot H, et al.:: Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology 1995, 108:1230–1235.

    Article  PubMed  CAS  Google Scholar 

  38. Tenner SM, Freedman S, Van Dam J: Identification of K-ras mutations: from microscope to endoscope. Gastroenterology 1996, 1:529–531.

    Article  Google Scholar 

  39. Mallery S, Quirk D, Lewandrowski K, et al.: EUS-guided FNA with cyst fluid analysis in pancreatic cystic lesions. Gastrointest Endosc 1998, 47:AB149.

    Google Scholar 

  40. Grimm H, Binmoeller KF, Soehendra N: Endosonographyguided drainage of a pancreatic pseudocyst. Gastrointest Endosc 1992, 38:170–171.

    PubMed  CAS  Google Scholar 

  41. Giovannini M, Bernardini D, Seitz JF. Cystogastrotomy entirely performed under endosonography guidance for oancreatic pseudocyst: results in six patients. Gastrointest Endosc 1998, 48:200–203.

    Article  PubMed  CAS  Google Scholar 

  42. Binmoeller KF, Seifert H, Soehendra N: Endosnography in pancreatic disease: interventional endosonography. In Gastrointestinal Endosonography. Edited by Van Dam J, Syvak MV. Philadelphia: WB Saunders; 1999:251–262.

    Google Scholar 

  43. Wiersema MJ, Wiersema LM: Endosonographically-guided celiac plexus neurolysis. Gastrointest Endosc 1996, 44:656–662.

    Article  PubMed  CAS  Google Scholar 

  44. Gunaratnam NT, Norton ID, Sarma AV, Wiersema MJ: Endosonography guided celiac plexus neurolysis (EUS CPN) for pancreatic cancer (PCA) pain: indications, efficacy, complications and patient outcomes [abstract]. Gastrointest Endosc 1999, 49:AB91.

    Google Scholar 

  45. Gress F, Schmitt C, Sherman S, et al.: A prospective randomized comparison of endoscopic ultrasound and computed tomography-guided celiac plexus block for the management of chronic pancreatitis pain. Am J Gastroenterol 1999, 94:900–905. Twenty-two patients with painful chronic pancreatitis were randomized to EUS or CT guided celiac plexus block (CPB). Initial pain relief was identified in 50% of EUS CPB patients versus 25% of CT CPB patients. EUS CPB was the preferred technique among patients who experienced both techniques.

    Article  PubMed  CAS  Google Scholar 

  46. Goldberg SN, Mallery S, Gazelle GS, Brugge WR: EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 1999, 50:392–401. Thirteen pigs underwent EUS guided radiofrequency ablation of the tail of the pancreas. Well-circumscribed regions of coagulative necrosis were identified on histology. Complications included one episode of pancreatitis and four episodes of gastrointestinal burn caused by improper electrode placement.

    Article  PubMed  CAS  Google Scholar 

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Sequeiros, E.V., Wiersema, M.J. The role of endoscopic ultrasonography in diagnosis staging, and management of pancreatic disease states. Curr Gastroenterol Rep 2, 125–132 (2000). https://doi.org/10.1007/s11894-000-0096-7

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