Personalized Approach to the Role of Endoscopic Ultrasound in the Diagnosis and Management of Pancreaticobiliary Malignancies

Abstract

Pancreaticobiliary malignancies arise from different areas within the pancreas and biliary tree. Endoscopic ultrasound (EUS) is a well-recognized diagnostic and therapeutic modality in the treatment of pancreaticobiliary diseases, and more specifically, pancreaticobiliary malignancies. Traditionally used for diagnostic purposes, EUS plays a critical role in tissue sampling and cancer staging. The emergence of the new field of interventional EUS has allowed EUS to also play a critical role in therapeutic management. Novel interventional EUS procedures such as EUS-guided gastrojejunostomy (EUS-GE), EUS-guided biliary drainage (EUS-BD), and EUS-guided gallbladder drainage (EUS-GLB) can be utilized to treat complications of pancreaticobiliary malignancies such as gastric outlet obstruction, obstructive jaundice, and cholecystitis. In addition, interventional EUS procedures can be utilized for the palliation of unresectable malignancies both for source control with EUS-radiofrequency ablation (EUS-RFA) and for the treatment of abdominal pain refractory to opioid medications with EUS-guided celiac axis neurolysis. However, patient selection remains a critical component in both diagnostic and therapeutic interventions and must be tailored to individual patient wishes, disease pathology, and overall prognosis.

Comparison of Endoscopic Ultrasonography Evaluation of suspected Pancreaticobiliary Malignancy in Patient with or without Biliary Decompression

“…Many studies had been conducted with the same aim and conducted the same result as a study during which they enrolled 123 patients with a better percentage of male patients (88 males (71.5%), 35 females (28%), and median age 61.3 years) (10) This is also in agreement with a study that enrolled 234 patients 127 males (54.2 %), 107 females (45.8%), median age 64) (11) As regards to sensitivity and specificity of EUS in detecting pancreatic and ampullary lesions, the results of EUS in detection of malignancy was relatively high in both groups. In group I, the EUS showed 92.5% sensitivity, 90.9% specificity, 92.18% accuracy, 98% PPV and 71.4% NPV in detection of malignancy.…”

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

“…An important role of EUS in gallbladder cancer diagnosis is to determine the invasion depth. EUS is a useful tool for assessing the tumor depth of invasion [ 24 , 25 ].…”

Role of EUS in Evaluating Causes of Biliary Obstruction not detected by other Imaging Modalities

“…This was in close agreement with Makar et al study. The sensitivity and specificity value for malignant obstruction detected by EUS was 97.5% and 97.6%, respectively, with PPV 95.1 % and NPV 98.8 %, and overall accuracy of 92.9% 11.…”