[Endoscopic ultrasound imaging in neuroendocrine pancreatic tumors. A critical analysis]

Endoscopic ultrasound enables imaging of the pancreas with high resolution. Today, it is considered to be the best preoperative imaging procedure in insulinomas. Since the result of endoscopic ultrasound may influence surgical strategy (minimally invasive approach), it needs to be performed in all patients. Furthermore, positive endoscopic ultrasound is able to confirm the diagnosis of insulinoma, since fasting test also may have been positive due to the intake of sulfonylureas or glinides which may have been missed Patiin toxicological analysis. However, false-positive and false-negative results always have to be taken into account. Gastrinomas which are located in the pancreas are usually detected by endoscopic ultrasound, yet often missed when localized in the duodenal wall. Thus, endoscopic ultrasound is not very helpful in treatment planning here. In multiple endocrine neoplasia type 1 (MEN1), endoscopic ultrasound is by far the best method to analyze the morphology of the pancreas. Clinical consequences are difficult, since the unclear prognosis of very small neuroendocrine pancreatic tumors in MEN1 on the one hand and possible side effects of surgical treatment (perioperative complications, diabetes mellitus following pancreatic surgery) on the other hand need to be discussed.