Subject(s)
Anticoagulants/adverse effects , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/complications , Jejunal Diseases/etiology , Jejunum/blood supply , Pulmonary Embolism/drug therapy , Varicose Veins/complications , Double-Balloon Enteroscopy , Humans , Hypertension, Portal/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed , Varicose Veins/diagnostic imagingABSTRACT
BACKGROUND: EUS often is performed because of a clinical suspicion of pancreatic cancer when the results of other noninvasive diagnostic tests are indeterminate. The aim of this study was to determine the true negative predictive value of a normal EUS in a cohort of patients with an indeterminate suspicion of pancreatic cancer by obtaining long-term follow-up information. METHODS: Patients referred for EUS of the pancreas for the following indications were identified: elevated carbohydrate-associated antigen (CA 19-9) without other definitive evidence of pancreatic cancer, subtle abnormalities on CT of the pancreas, and unexplained abdominal pain and/or weight loss. Endoscopy procedure reports, as well as inpatient and outpatient records were obtained. In addition, referring physicians, as well as patients, were contacted to acquire adequate follow-up information. RESULTS: A total of 80 patients were included in the study. Follow-up of at least 6 months was obtained for 76 (95%) patients (mean follow-up 23.9 months). No patient with a normal EUS of the pancreas developed pancreatic cancer or required pancreatic surgery during the follow-up period. One patient in whom a diagnosis of chronic pancreatitis was made by EUS subsequently was found to have pancreatic cancer at surgery. CONCLUSIONS: A normal EUS of the pancreas in the setting of subtle radiologic findings, serologic abnormalities, and/or nonspecific symptoms definitively rules out the presence of pancreatic cancer.
