Clinical Endoscopy

Review

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects: Clement Chun Ho Wu, Samuel Jun Ming Lim, Damien Meng Yew Tan; Clin Endosc 2024;57(4):434-445. Published online July 8, 2024; DOI: https://doi.org/10.5946/ce.2023.157

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

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Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino, Giovanni Lombardi
Gastroenterology Insights.2024; 15(3): 810. CrossRef

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Original Article

Is antibiotic prophylaxis necessary after endoscopic ultrasound–guided fine-needle aspiration of pancreatic cysts?: Seifeldin Hakim, Mihajlo Gjeorgjievski, Zubair Khan, Michael E. Cannon, Kevin Yu, Prithvi Patil, Roy Tomas DaVee, Sushovan Guha, Ricardo Badillo, Laith Jamil, Nirav Thosani, Srinivas Ramireddy; Clin Endosc 2022;55(6):801-809. Published online November 10, 2022; DOI: https://doi.org/10.5946/ce.2021.150

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Background
/Aims: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics.
Methods
We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted.
Results
A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB– group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography.
Conclusions
The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

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Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis
Patrick T. Magahis, Ankit Chhoda, Tyler M. Berzin, James J. Farrell, Drew N. Wright, Anam Rizvi, Mark Hanscom, David L. Carr-Locke, Kartik Sampath, Reem Z. Sharaiha, SriHari Mahadev
American Journal of Gastroenterology.2024; 119(11): 2174. CrossRef
III BRAZILIAN CONSENSUS STATEMENT ON ENDOSCOPIC ULTRASOUND
Ricardo Rangel de Paula PESSOA, Alexandre Moraes BESTETTI, Victor Lira de OLIVEIRA, Wladimir Campos de ARAUJO, Simone GUARALDI, Rodrigo Roda RODRIGUES SILVA, Francisco Antonio Araujo OLIVEIRA, Maria Sylvia Ierardi RIBEIRO, Fred Olavo Aragão Andrade CARNEI
Arquivos de Gastroenterologia.2024;[Epub] CrossRef

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Systematic Review and Meta-Analysis

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis: Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral; Clin Endosc 2022;55(2):197-207. Published online November 29, 2021; DOI: https://doi.org/10.5946/ce.2021.079

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Background
/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE).
Methods
We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations.
Results
Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization.
Conclusions
CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Citations

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Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma
Roxana-Luiza Caragut, Madalina Ilie, Teodor Cabel, Deniz Günșahin, Afrodita Panaitescu, Christopher Pavel, Oana Mihaela Plotogea, Ecaterina Mihaela Rînja, Gabriel Constantinescu, Vasile Sandru
Diagnostics.2024; 14(5): 490. CrossRef
Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms
Shreyas Krishna, Ahmed Abdelbaki, Phil A. Hart, Jorge D. Machicado
Cancers.2024; 16(6): 1238. CrossRef
Exploring Intestinal Permeability: Concept, Diagnosis, Connection to Bowel Disease, and Iron Deficiency
Olesja Basina, Aleksejs Derovs, Jeļena Derova, Sandra Lejniece
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2024; 78(4): 244. CrossRef
American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations
Larissa L. Fujii-Lau, Nirav C. Thosani, Mohammad Al-Haddad, Jared Acoba, Curtis J. Wray, Rodrick Zvavanjanja, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu, Madhav Desai, Sherif E. Elhanafi, Douglas S
Gastrointestinal Endoscopy.2023; 98(5): 685. CrossRef
In Vivo Click Chemistry Enables Multiplexed Intravital Microscopy
Jina Ko, Kilean Lucas, Rainer Kohler, Elias A. Halabi, Martin Wilkovitsch, Jonathan C. T. Carlson, Ralph Weissleder
Advanced Science.2022;[Epub] CrossRef
Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
Woo Hyun Paik
International Journal of Gastrointestinal Intervention.2022; 11(3): 96. CrossRef

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Case Report

Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst: Jessica Cassiani, Stefano Francesco Crinò, Erminia Manfrin, Matteo Rivelli, Armando Gabbrielli, Alfredo Guglielmi, Corrado Pedrazzani; Clin Endosc 2021;54(5):767-770. Published online February 17, 2021; DOI: https://doi.org/10.5946/ce.2020.195

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A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.

Citations

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Optimal resection of gastric bronchogenic cysts based on anatomical continuity with adherent gastric muscular layer: A case report
Masayoshi Terayama, Koshi Kumagai, Hiroshi Kawachi, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Manabu Ohashi, Takeshi Sano, Souya Nunobe
World Journal of Gastrointestinal Surgery.2023; 15(6): 1216. CrossRef
Retroperitoneal tumor finally diagnosed as a bronchogenic cyst: A case report and review of literature
Yang-Yang Gong, Xin Qian, Bo Liang, Ming-Dong Jiang, Jun Liu, Xing Tao, Jing Luo, Hong-Jian Liu, You-Gang Feng
World Journal of Clinical Cases.2022; 10(19): 6679. CrossRef
Endoscopic resection in the treatment of intramural esophageal bronchogenic cysts: A retrospective analysis of 17 cases
Jiao Jiao, Xiaofei Fan, Lili Luo, Zhongqing Zheng, Bangmao Wang, Wentian Liu
Digestive and Liver Disease.2022; 54(12): 1691. CrossRef
Subdiaphragmatic bronchogenic cysts: Case series and literature review
Jianchun Xiao, Xueyang Zhang, Hongru Zhou, Tao Hong, Binglu Li, Xiaodong He, Wei Liu
Frontiers in Medicine.2022;[Epub] CrossRef

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Original Article

Cyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms: Ibrahim Hakkı Köker, Nurcan Ünver, Fatma Ümit Malya, Ömer Uysal, Elmas Biberci Keskin, Hakan Şentürk; Clin Endosc 2021;54(1):113-121. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.083

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Background
/Aims: The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions (PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinous neoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs).
Methods
This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspiration over a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereas high-grade dysplasia and invasive carcinoma were considered HR.
Results
Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range) levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5–266,510] ng/mL vs. 100 [16.8–53,445]ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5–0.8; p<0.001) for differentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823–1.000; p<0.001) for differentiating LR-IPMNs from HR-IPMNs. Both had a CEA cutoff level of >100ng/mL, with a negative predictive value (NPV) of 100%.
Conclusions
Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.

Citations

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An Overview for Clinicians on Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas
Dimitrios Moris, Ioannis Liapis, Piyush Gupta, Ioannis A. Ziogas, Georgia-Sofia Karachaliou, Nikolaos Dimitrokallis, Brian Nguyen, Pejman Radkani
Cancers.2024; 16(22): 3825. CrossRef
Spectrum of MRI Features of Mucin-producing Neoplasms in the Abdomen and Pelvis
Pei-Kang Wei, Mamta Gupta, Leo L. Tsai, Karen S. Lee, Adrian M. Jaramillo, Martin P. Smith, Jordan D. LeGout, Anuradha S. Shenoy-Bhangle
RadioGraphics.2022; 42(2): 469. CrossRef
Is Carcinoembryonic Antigen the Holy Grail for Pancreatic Cyst Risk Stratification?
Ahmad Najdat Bazarbashi, Linda S. Lee
Clinical Endoscopy.2021; 54(1): 7. CrossRef
Deep Learning-Based Differentiation between Mucinous Cystic Neoplasm and Serous Cystic Neoplasm in the Pancreas Using Endoscopic Ultrasonography
Leang Sim Nguon, Kangwon Seo, Jung-Hyun Lim, Tae-Jun Song, Sung-Hyun Cho, Jin-Seok Park, Suhyun Park
Diagnostics.2021; 11(6): 1052. CrossRef

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Review

The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review: Yung Ka Chin, Clement Chun Ho Wu, Damien Meng Yew Tan; Clin Endosc 2021;54(1):38-47. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.200-IDEN

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The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.

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Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression
Yan Hu, Dan Jones, Ashwini K. Esnakula, Somashekar G. Krishna, Wei Chen
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Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases
Jia Huang, Xiaofei Fan, Wentian Liu
Diagnostics.2023; 13(17): 2815. CrossRef
EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts
Michele T. Yip-Schneider, Rodica Muraru, Rachel C. Kim, Howard H. Wu, Stuart Sherman, Aditya Gutta, Mohammad A. Al-Haddad, John M. Dewitt, C. Max Schmidt
HPB.2023; 25(12): 1587. CrossRef
Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey
Hyung Ku Chon, Sung Hoon Moon, Sang Wook Park, Woo Hyun Paik, Chang Nyol Paik, Byoung Kwan Son, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Jae Min Lee, Tae Joo Jeon, Chang-Hwan Park, Kwang Bum Cho, Dong Wook Lee
The Korean Journal of Internal Medicine.2022; 37(1): 63. CrossRef
Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral
Clinical Endoscopy.2022; 55(2): 197. CrossRef
Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions
Jorge D. Machicado, Bertrand Napoleon, Anne Marie Lennon, Samer El-Dika, Stephen P. Pereira, Damien Tan, Rahul Pannala, Mohit Girotra, Pradermchai Kongkam, Helga Bertani, Yunlu Feng, Hao Sijie, Ning Zhong, Vincent Valantin, Sarah Leblanc, Alice Hinton, So
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Wei Chen, Nehaal Ahmed, Somashekar G. Krishna
Diagnostics.2022; 13(1): 65. CrossRef
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Ralf Kiesslich
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Case Report

Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report: Jung Won Chun, Sang Hyub Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim; Clin Endosc 2019;52(5):510-515. Published online July 4, 2019; DOI: https://doi.org/10.5946/ce.2018.191

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The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

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John C. Rowe, Alice A. Huang, Jin Heo, Nolie K. Parnell, Adam J. Rudinsky
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Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng
World Journal of Gastroenterology.2020; 26(23): 3213. CrossRef

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Reviews

A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease: Kunal Karia, Michel Kahaleh; Clin Endosc 2016;49(5):462-466. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.086

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Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.

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Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses: Jaihwan Kim; Clin Endosc 2015;48(4):308-311. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.308

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Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics. Recently, there have been several innovative trials on the treatment of pancreatic tumors using endoscopic ultrasound (EUS) because it allows selective access to the difficult to reach target organ along the gastrointestinal tract and can differentiate vessels by color Doppler. Among these trials, several have investigated EUS-guided ethanol lavage with or without paclitaxel for pancreatic cystic tumors. These studies show a 33% to 79% complete resolution rate with a favorable safety profile. Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer. Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases

Rare Nonneoplastic Cysts of Pancreas: Yeon Suk Kim, Jae Hee Cho; Clin Endosc 2015;48(1):31-38. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.31

Abstract PDF PubReader ePub

Pancreatic cysts represent a small proportion of pancreatic diseases, but their incidence has been recently increasing. Most pancreatic cysts are identified incidentally, causing a dilemma for both clinicians and patients. In contrast to ductal adenocarcinoma, neoplastic pancreatic cysts may be cured by resection. In general, pancreatic cysts are classified as neoplastic or non-neoplastic cysts. The predominant types of neoplastic cysts include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms. With the exception of serous type, neoplastic cysts, have malignant potential, and in most cases requires resection. Non-neoplastic cysts include pseudocyst, retention cyst, benign epithelial cysts, lymphoepithelial cysts, squamous lined cysts (dermoid cyst and epidermal cyst in intrapancreatic accessory spleen), mucinous nonneoplastic cysts, and lymphangiomas. The incidence of nonneoplastic, noninflammatory cysts is about 6.3% of all pancreatic cysts. Despite the use of high-resolution imaging technologies and cytologic tissue acquisition with endosonography, distinguishing nonneoplastic from neoplastic cysts remains difficult with most differentiations made postoperatively. Nonetheless, the definitive distinction between non-neoplastic and neoplastic cysts is crucial as unnecessary surgery could be avoided with proper diagnosis. Therefore, consideration of these rare disease entities should be entertained before deciding on surgery.

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Special Issue Article of IDEN 2013

Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?: Prashant Kedia, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(5):552-562. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.552

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

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Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions
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Optimal Techniques for EUS-Guided Fine-Needle Aspiration of Pancreatic Solid Masses at Facilities without On-Site Cytopathology: Results from Two Prospective Randomised Trials
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Journal of Clinical Medicine.2021; 10(20): 4662. CrossRef
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High-resolution endoscopic ultrasound imaging and the number of needle passages are significant factors predicting high yield of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses without an on-site cytopathologist
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Chaoqun Han, Rong Lin, Qin Zhang, Jun Liu, Zhen Ding, Xiaohua Hou
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Hong-Yu Li, Zhong-Min Cui, Jiang Chen, Xiao-Zhong Guo, Ying-Yi Li
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Key endoscopic ultrasound features of pancreatic ductal adenocarcinoma smaller than 20 mm
Akira Aso, Eikichi Ihara, Takashi Osoegawa, Kazuhiko Nakamura, Soichi Itaba, Hisato Igarashi, Tetsuhide Ito, Shinichi Aishima, Yoshinao Oda, Masao Tanaka, Ryoichi Takayanagi
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Clinical Endoscopy.2014; 47(5): 425. CrossRef

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Case Report

One Case of Common Bile Duct Cancer Mimicking Cystic Neoplasm of the Pancreas, Arising 9 Years after Excision of a Choledochal Cyst: Sang Wook Park, Sang Hyub Lee, Young Ook Eum, Hong Sang Oh, Donghyeon Lee, Eunhyo Jin, Kwanghyun Chung, Jin-Hyeok Hwang; Clin Endosc 2012;45(4):435-439. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.435

Abstract PDF PubReader ePub

A 42-years-old woman had undergone operation for cholecochal cyst with gallbladder cancer 9 years ago. Pathology revealed a polypoid mass in the gallbladder with liver infiltration as poorly differentiated adenocarcinoma. Computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound showed a newly developed suspected solid nodule in the peripheral portion of cystic lesion in the pancreas head. She underwent a pylorus preserving pancreaticoduodenectomy for the suspected mucinous cystic neoplasm of the pancreas. Pathology revealed poorly differentiated adenocarcinoma. The remnant choledochal cyst had developed to cholangiocarcinoma, which mimicked cystic neoplasm of the pancreas.

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Carcinoma of the Papilla of Vater after Diversion Operation for Pancreaticobiliary Maljunction
Takahiro Yamanaka, Kenichiro Araki, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Norio Kubo, Hiroyuki Kuwano, Ken Shirabe
Case Reports in Gastroenterology.2017; 11(2): 265. CrossRef
Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts
Hong-Tian Xia, Tao Yang, Bin Liang, Jian-Ping Zeng, Jia-Hong Dong
Surgery.2016; 159(2): 418. CrossRef

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췌장의 림프상피성 낭종 1예 ( A Case of a Lymphoepithelial Cyst of the Pancreas ): Korean J Gastrointest Endosc 2000;20(3):218-221. Published online November 30, 1999

Abstract PDF: Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.

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원저 : 췌장의 낭성병변에서 ERCP 의 진단적 의의 ( Original Articles : Diagnostic Value of ERCP in Pancreatic Cystic Lesions ): Korean J Gastrointest Endosc 1994;14(2):175-181. Published online November 30, 1993

Abstract PDF: The majority of cystic lesions of the pancreas are psudocysts and a small fraction neoplastic. Failure to recognize the true nature of neoplastic cyst will lead to an incorrct treatment strategy. Ultrasonography, computerized tomography and angiography were used to distingish these lesions, but diagnostic value of ERCP is in controversy. To evaluate the diagnostic value of ERCP in cystic lesions of the pancreas, we analysed 33 cases of pancreatic cystic lesions (pseudocyst 18 cases, retention cyst 3 cases and cystic, neoplasm l2 cases) between Apr. 1985 and June 1993. In 18 cases of pseudocysts, ERP findings were communication with cyst in 8 cases (44.4%), chronic pancreatitis in 8 cases (44.4%), obstruction in 4 cases (22.2%) and displscement of pancreatic duct in 2 cases (11.1%), and ERC findings, which were perfomed in 8 cases, showed cholangitis in 3 cases (37.5%), CBD stone in 2 cases (25%), mass effect in 1 case (12.5%) and normal in 2 cases (25%). There was no communication with the cyst and pancreatic duct, except two mucinous ductal ectasia, in 12 cases of cystic neoplasms, and the other findings were displacement of pancreatic duct in 4 cases (33.3%), obstruction in 2 cases (16.7%) and normal in 4 cases (33.3%). ERC findings of cystic neoplasm were almost normal (85.7%) except 1 case of cholangitis. In conclusion, ERCP findings of pseudocysts were communication with pancreatic duct, chronic pancreatitis and biliary tract abnormality. In contrast, ERCP findings of cystic neoplasms were displacement or obstruction of pancreatic duct without communication and chronic pancreatitis, and biliary tract abnormality were rare.

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