Ductal adenocarcinoma accounts for 90% of all pancreatic malignancies and is the fourth leading malignant cause of mortality in the Western world and the fifth in Russia. Comprehensive preoperative examination is aimed not only at making an accurate diagnosis, but also at determining treatment strategy. The diagnostic algorithm involves endoscopic ultrasound. The modern possibilities of endosonography combined with tissue contrast enhancement and fine-needle aspiration, as well as some aspects of palliative endoscopic treatment are analyzed in the article.

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Aim. To study the possibilities of endoscopic ultrasonography with contrast enhancement and fine-needle biopsy in the diagnosis of metastatic lesions of the pancreas.Materials and methods. 299 patients with solid pancreatic neoplasms were examined in the period from 2016 to 2018. Among them, adenocarcinoma of pancreas was diagnosed in 96.3% (n= 288), in 3.7% of cases (n= 11) a secondary lesion of the pancreas was suspected due to the presence of a tumor of another localization. Endosonography with contrast enhancement and fine-needle biopsy was performed for all these patients.Results. In 7 of 11 patients, there was a primary lesion of the pancreas (ductal adenocarcinoma), confirmed by morphological research data from a fine-needle biopsy. Of the 11 cases, the metastatic lesion of the gland was morphologically verified in 4 (36.4%) cases. In 2 cases, metastases of renal cell carcinoma were diagnosed, 1 was metastasis of small cell lung cancer, and 1 was metastases of colorectal cancer. Patients with secondary lesions of the pancreas accounted for 1.3% of the total number of patients.Conclusion. In the presented clinical observations, the possibilities of endo-ultrasound with contrast enhancement were analyzed, as well as the prospect of cytological and immunocytochemical studies in situations where the material obtained during fine-needle puncture is insufficient for histological examination. Such an approach is fully justified and helps to clarify the nature of the neoplasm in difficult situations.

В настоящее время все более весомое значение в решении сложных задач дифференциальной диагностики заболеваний панкреатобилиарной системы отводится эндоскопической ультрасонографии (ЭУС, EUS) Развитие технологий УЗИ способствовало внедрению в клиническую практику методики контрастного усиления (CH) Эндосонография, дополняемая контрастированием изучаемого объекта, значительно увеличивает информативность метода, расширяет возможности дифференциальной диагностики как солидных, так и кистозных образований поджелудочной железы Актуальной задачей является оценка диагностической точности и определение места ЭУС-контрастного усиления (CH-EUS) в диагностическом алгоритме обследования пациентов с заболеваниями поджелудочной железы В статье приведен обзор результатов исполь зования CH-EUS европейскими и японскими исследователями Ключевые слова: эндоскопическая ультрасонография, контрастное усиление, поджелудочная железа, солидное образование, кистозные неоплазии.