Endoscopic ultrasound in the diagnosis and therapy of chronic pancreatitis

Abstract

Endoscopic ultrasound (EUS) has been shown to be a useful tool in the staging of gastrointestinal, pancreaticobiliary, and mediastinal malignancies. EUS also plays a significant role in the evaluation of submucosal tumors, and its therapeutic role in celiac plexus neurolysis has been established in the setting of malignancy. Previously, the retroperitoneum has been difficult to image by conventional imaging modalities such as transabdominal ultrasound and computed tomography (CT) scan. Although endoscopic retrograde cholangiopancreatography (ERCP) is considered by many to be the gold standard for diagnosing chronic pancreatitis, it does not give information on the pancreatic parenchymal changes that may be seen in the early stages of chronic pancreatitis. EUS is highly sensitive in imaging the pancreas. In patients with a suspicion of chronic pancreatitis, especially in early stages, this is an invaluable tool. EUS appears to be more sensitive than ERCP and secretin testing in diagnosing mild chronic pancreatitis and thus may help to direct therapy. EUS-guided fine-needle aspiration is useful when pancreatic carcinoma is suspected in patients with chronic pancreatitis.