ABSTRACT
Background: Pancreas is a deeply seated organ and difficult to investigate. Many studies have appeared comparing Endoscopic Ultrasonography [EUS] with various other pancreatic imaging techniques, and proved that [EUS] has emerged as the most accurate single test for imaging pancreatic disease
Introduction: Many investigators proved that EUS was superior to other investigation modalities, and could be used both as conventional and interventional modality. EUS is capable of evaluating and integrating: mucosal, vascular, ductal and parenchymal abnormalities caused by disease. To obtain information about these 4 types of abnormalities; 4 separate tests are often required: endoscopy for mucosa, venogram or arteriogram for veins and arteries. ERCP for ducts: and CT scan or standard US for parenchyma and lymph nodes
Aim of the Work: To evaluate the value of EUS in pre-operative assessment of pancreatic lesions
Patients and Methods: Thirty patients were included in this study, all of them were diagnostically problematic. All had symptoms related to pancreato-biliary disease, but had either no diagnosis after conventional studies, or probable malignancy with uncertain tumor stage or resection status. All of them were subjected to EUS examination in addition to full clinical examination, laboratory investigations and other imaging modalities [U/S, spiral CT and ERCP]. The imaging findings were compared with both operative and histopathological findings for tumor status and vascular involvement
Results: male to female ratio was 3:2, with high frequency in the age group of 65- years. In diagnosis of pancreatic cancer EUS was able to detect mass that coincide with operative findings and histopathology in 80% of the cases, as compared with US [28 %] and CT [48 %]. In pancreatic cysts, EUS was as sensitive as both US and CT., while in chronic pancreatitis, EUS was more sensitive [100%] than both CT [66%] and US [0%]. EUS was superior to spiral CT in diagnosis of vascular invasion [8 versus 4 respectively], while CT was superior in detecting lymph node involvement [4 versus 8 respectively]
Conclusion: EUS is a good partially invasive modality, more sensitive than other imaging modalities in diagnosis of pancreatic lesions particularly those less than 3 cm in diameter. It can detect chronic pancreatitis in patients where other tests have not shown diagnostic findings. It can predict the unresectable cases and then preclude unnecessary exploration, and so prevent the morbidity and the cost of an unnecessary surgical procedure