Recent developments in endoscopic ultrasound-guided diagnosis and therapy of pancreatic cystic neoplasms

ABSTRACT

This review highlights new developments in the field of endoscopic ultrasound (EUS)-guided diagnosis and therapy of pancreatic cystic neoplasms. Studies pertinent to pancreatic cyst diagnosis by morphology, namely diagnostic accuracies of various criteria such as pancreatic cyst size, pancreatic duct size, mural nodules and use of EUS contrast agent are discussed. Tissue acquisition during EUS using a novel brush for cytology as well as microforceps is explored further. The role of multiple emerging molecular markers such as CEA, BRAF, KRAS, and GNAS, to name a few, is covered in detail. Recent developments relating to the utility of micro-RNAs in the analysis of cyst fluid is explored. Needle based confocal laser endomicroscopy for pancreatic cyst imaging is a recent development, and findings from recent trials are discussed. Furthermore, recent data regarding the role of ablative therapies using alcohol, paclitaxel and radiofrequency ablation of cyst is covered. Also, given the multiplicity of guidelines regarding management of pancreatic cystic neoplasms, we discuss the merits and shortcoming of these guidelines.