The diagnostic value of endoscopic ultrasonography in pancreatic disorders

The introduction of endoscopic ultrasonography (EUS) makes it possible to demonstrate the pancreas in detail by intraluminal scanning. To assess the clinical usefulness of EUS in the diagnosis of pancreatic disorders, 33 patients with various pancreatic disorders were examined by conventional ultrasonography (US) and EUS concomitantly. There were 16 patients with pancreatic carcinomas: 7 chronic pancreatitis, 5 pseudocysts, 2 mucinous cystadenocarcinomas, one each serous cystadenoma, Von-Hippel-Lindau disease, and simple cyst of the pancreas. An Olympus EUS (Japan) radial type machine with a 7.5 MHz transducer with the balloon inflation method was used. The overall diagnostic sensitivity of conventional US (90.9%, 30/33) was as high as that of EUS (93.9%, 31/33), but the latter demonstrated pancreatic parenchyma more clearly. Three patients were misdiagnosed by conventional US. One patient with chronic calcifying pancreatitis, which was initially diagnosed as dilatation of the main pancreatic duct without evidence of calcifications by conventional US, was confirmed to have a trace of calcification by EUS and computed tomography. Two other patients, whose initial diagnosis was pseudocyst, were proved to have mucinous cystadenocarcinoma and serous cystadenoma respectively by EUS, as a result of improved image resolution. Two patients were misdiagnosed by EUS. One patient with carcinoma of the pancreatic head was missed by EUS because of a partially gastrectomized stomach which precluded successful observation. The other patient with cystadenocarcinoma of the pancreatic tail was misdiagnosed as pseudocyst by EUS due to non-visualization of a papillary crescent within a cystic tumor. We conclude that EUS and conventional US were complementary.(ABSTRACT TRUNCATED AT 250 WORDS)