EUS and K- ras analysis of pure pancreatic juice collected via a duodenoscope after secretin stimulation for diagnosis of pancreatic mass lesion: a prospective study

Abstract

Background: The early diagnosis of pancreatic cancer remains problematic. This prospective study assessed the utility of a combination of endoscopic ultrasound (EUS) and genetic analysis of pure pancreatic juice in the diagnosis of pancreatic mass lesions. Methods: One hundred seventy-six patients with suspected pancreatic disease were enrolled and underwent ultrasonography (US), computed tomography (CT), endoscopic retrograde choleangiopancreatography (ERCP), and EUS. Pure pancreatic juice was collected endoscopically after secretin stimulation. K- ras point mutations at codon 12 in the juice were assayed by polymerase chain reaction–restriction fragment length polymorphism. Results: Thirty-six (20%) patients were found to have solid pancreatic masses including 19 with cancer (7 patients, ≤ 2 cm) and 17 patients with an inflammatory mass (13 patients, ≤ 2 cm). US and CT were both less sensitive, particularly in patients with small masses. In 13 patients, small masses (4 cancer and 9 inflammatory masses) were not delineated until EUS. The combination of EUS and K- ras analysis had a high sensitivity (100%; p < 0.05 vs. US) and its accuracy reached 94% ( p < 0.01 vs. US). Conclusions: EUS and K- ras determination in pure pancreatic juice collected via a duodenoscope may be useful for the diagnosis of pancreatic mass lesions. (Gastrointest Endosc 1999;50:797-803.)