scholarly journals Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 238
Author(s):  
Yasutaka Ishii ◽  
Masahiro Serikawa ◽  
Tomofumi Tsuboi ◽  
Ryota Kawamura ◽  
Ken Tsushima ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasonography ◽  
Treatment Decision ◽  
Needle Aspiration ◽  
Pancreatic Tumors ◽  
Decision Strategy ◽  
Endoscopic Retrograde ◽  
Small Pancreatic Cancer ◽  
Eus Elastography

Pancreatic cancer has the poorest prognosis among all cancers, and early diagnosis is essential for improving the prognosis. Along with radiologic modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic modalities play an important role in the diagnosis of pancreatic cancer. This review evaluates the roles of two of those modalities, endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), in the diagnosis of pancreatic cancer. EUS can detect pancreatic cancer with higher sensitivity and has excellent sensitivity for the diagnosis of small pancreatic cancer that cannot be detected by other imaging modalities. EUS may be useful for the surveillance of pancreatic cancer in high-risk individuals. Contrast-enhanced EUS and EUS elastography are also useful for differentiating solid pancreatic tumors. In addition, EUS-guided fine needle aspiration shows excellent sensitivity and specificity, even for small pancreatic cancer, and is an essential examination method for the definitive pathological diagnosis and treatment decision strategy. On the other hand, ERCP is invasive and performed less frequently for the purpose of diagnosing pancreatic cancer. However, ERCP is essential in cases that require evaluation of pancreatic duct stricture that may be early pancreatic cancer or those that require differentiation from focal autoimmune pancreatitis.

scholarly journals Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer

Diagnostics ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 15 ◽  
Author(s):  
Shuzo Terada ◽  
Masataka Kikuyama ◽  
Shinya Kawaguchi ◽  
Hideyuki Kanemoto ◽  
Yoshihiro Yokoi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasonography ◽  
Invasive Carcinoma ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tumor Type ◽  
Cytologic Examination ◽  
Small Pancreatic Cancer ◽  
Invasive Carcinomas

Backgrounds: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. Materials and Methods: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type—no findings around the stricture; A2: Hypoecho stricture type—localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type—tumor on the stricture; B: Dilation type—the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type—tumor located apart from the MPD. Results: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. Conclusions: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC.

scholarly journals Rendezvous for afferent limb syndrome

2020 ◽  
Vol 2 (9) ◽  
pp. 01-04
Author(s):  
Ivan Mendez
Keyword(s):  
Pancreatic Cancer ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Stent Placement ◽  
Whipple Procedure ◽  
Metallic Stent ◽  
Biliary Anatomy ◽  
Endoscopic Retrograde ◽  
Afferent Limb ◽  
Rendezvous Technique ◽  
Metallic Stent Placement

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgical alterations in the normal biliary anatomy is technically challenging. We describe the case of a 73-year-old patient with an afferent limb syndrome secondary to a Whipple procedure for pancreatic cancer, in which a percutaneous rendezvous technique assisted in the endoscopic metallic stent placement with favorable outcome.

scholarly journals The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1005
Author(s):  
Atsushi Kanno ◽  
Eriko Ikeda ◽  
Kozue Ando ◽  
Hiroki Nagai ◽  
Tetsuro Miwata ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasonography ◽  
Autoimmune Pancreatitis ◽  
Wall Thickening ◽  
Endoscopic Retrograde ◽  
Intraductal Ultrasonography ◽  
Bile Duct Wall ◽  
Duct Wall

Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.

scholarly journals Endoscopic Ultrasonography-Guided Fine Needle Aspiration for Extrahepatic Cholangiocarcinoma: A Safe Tissue Sampling Modality

2019 ◽  
Vol 8 (4) ◽  
pp. 417 ◽  
Author(s):  
Takumi Onoyama ◽  
Kazuya Matsumoto ◽  
Yohei Takeda ◽  
Soichiro Kawata ◽  
Hiroki Kurumi ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Biliary Disease ◽  
Tissue Sampling ◽  
Endoscopic Retrograde ◽  
Extrahepatic Cholangiocarcinoma ◽  
Fine Needle ◽  
Pathological Evaluation ◽  
Sensitivity Specificity

Few studies have compared the diagnostic utility of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling for extrahepatic cholangiocarcinoma (ECC). We evaluated the efficacy and safety of EUS-FNA for diagnosing ECC compared with ERCP tissue sampling. Patients who underwent EUS-FNA or ERCP tissue sampling to differentiate ECC from benign biliary disease were enrolled retrospectively between October 2011 and March 2017. We evaluated diagnostic performances of EUS-FNA and ERCP tissue sampling based on pathological evaluation. We compared adverse events in EUS-FNA and ERCP tissue sampling. We enrolled 73 patients with biliary disease and performed EUS-FNA and ERCP in 19 and 54 patients, respectively. Sensitivity, specificity, and accuracy of ERCP tissue sampling were 76.0%, 100%, and 88.9%, respectively, and for EUS-FNA these were 81.8%, 87.5%, and 84.2%, respectively. Statistical values of ERCP tissue sampling and EUS-FNA were not significantly different. The adverse event frequency of EUS-FNA was significantly lower than that of ERCP tissue sampling (0% vs. 25.9%, p = 0.033). The diagnostic ability of EUS-FNA for ECC is similar to that of ERCP tissue sampling. EUS-FNA is a safer tissue sampling modality than ERCP for evaluating biliary disease.

EARLY DIAGNOSIS OF SMALL PANCREATIC CANCER: ROLE OF ENDOSCOPIC ULTRASONOGRAPHY

2009 ◽  
Vol 21 ◽  
pp. S92-S96 ◽  
Author(s):  
Atsushi Irisawa ◽  
Ai Sato ◽  
Masaki Sato ◽  
Tsunehiko Ikeda ◽  
Rei Suzuki ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Early Diagnosis ◽  
Endoscopic Ultrasonography ◽  
Small Pancreatic Cancer

scholarly journals Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Early Diagnosis of Small Pancreatic Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 23 ◽  
Author(s):  
Yasunobu Yamashita ◽  
Kensuke Tanioka ◽  
Yuki Kawaji ◽  
Takashi Tamura ◽  
Junya Nuta ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Early Diagnosis ◽  
Endoscopic Ultrasonography ◽  
Multidetector Row Computed Tomography ◽  
Diagnostic Ability ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri ◽  
Pancreatic Solid Lesion ◽  
Small Pancreatic Cancer ◽  
Sensitivity Specificity

This study aimed to assess whether contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), compared to multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), is useful for early diagnosis of small pancreatic cancer (PC). Between March 2010 and June 2018, all three imaging modalities and surgery were performed for patients with a pancreatic solid lesion measuring ≤20 mm; diagnostic ability was compared among modalities. Fifty-one of 60 patients were diagnosed with PC (PC size in 41 patients: 11–20 mm; 10 patients: ≤10 mm). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (11–20 mm) detection were 95%/83%/94%, 78%/83%/79%, and 73%/33%/68%, respectively. The diagnostic ability of CH-EUS was significantly superior compared with MDCT and MRI (p = 0.002 and p = 0.007, respectively). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (≤10 mm) detection were 70%/100%/77%, 20%/100%/38%, and 50%/100%/62%, respectively. The diagnostic ability of CH-EUS tended to be superior to that of MDCT (p = 0.025). The sensitivity of MDCT for PC (≤10 mm) detection was significantly lower than that for PC (11–20 mm) detection (20% vs. 78%; p = 0.001). CH-EUS, compared to MDCT and MRI, is useful for diagnosing small PCs.

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