Mo1363 USEFULNESS OF CONTRAST-ENHANCED EUS FOR PANCREATICOBILIARY DISEASES -SINGLE CENTER 436 CASES-

Abstract

Endoscopic ultrasonography (EUS) is a modality with high resolution. Recently, EUS has made it possible to use new diagnostic imaging techniques, namely contrast-enhanced EUS (CE-EUS) to allow the characteristics of the mass form the view point of vascularity using intravenous contrast agent. However, so far several studies with limited number of cases have been reported. Thus, in the present study, we evaluated the significance of CE-EUS in large number of patients with pancreaticobiliary diseases. CE-EUS was performed for 436 cases of pancreaticobiliary disease which was difficult to diagnose by other imaging such as CT, MRI and conventional EUS, from April 2013 to October 2017. Three experienced endoscopists of pancreatobiliary disease evaluated the usefulness of CE-EUS retrospectively. EUS device system was HI VISION900 or HI VISION Avius (Hitachi Aloka Medical, Inc.) and, EG3870UTK endoscope (Pentax Co., Ltd.), or using EU-ME2 (Olympus medical systems) and UCT260 endoscope (Olympus medical systems) or SU1 (FUJIFILM Medical Co., Ltd) and EG 580 UT endoscope (FUJIFILM Medical Co., Ltd). The contrast agent used was Sonazoid® (DAIICHI SANKYO COMPANY). CE-EUS was performed after the B-mode EUS observation. The patients’ male/female ratio was 5:3, their mean age was 68.9 years old (29-93). Pancreatic mass lesion in 222 cases, pancreatic cystic lesion in 146 cases, gallbladder disease in 52cases, bile duct disease in 12 cases and walled-off necrosis (WON) in 4 cases. In case of pancreatic mass lesion, the findings of CE-EUS, such as hypovascular contrast pattern and irregular vascular pattern, was useful in 81% (69/85) for diagnose of pancreatic cancer. The contrast pattern of neuroendocrine tumor (NET) was similar to that of solid-pseudopapillary neoplasm (SPN), so that diagnosis accuracy was low (40%, 23/58) and it was difficult to differentiate. In pancreatic cystic lesions, it was possible to differentiate between solid component and debris or mucus lump at 95% (138/146), which was useful. In gallbladder diseases, it was possible to distinguish between tumor and debris in 100% (10/10), and differentiation between benign and malignant in gallbladder elevated lesions was possible in 70% (23/33). In bile duct diseases, tumor and debris could be distinguished 100% (4/4), however diagnostic rate of benign and malignant was 63% (5/8). In case of WON, CE-EUS was useful in selecting the puncture site at the time of endoscopic cyst drainage (ECD) in 100% (4/4). CE-EUS was useful for the diagnosis of pancreatic cancer and for differentiating between solid components and debris or mucus lump in pancreatic cystic lesions. However, it was considered that differentiation between benign and malignant except pancreatic cancer was difficult by CE-EUS.