NEW OPPORTUNITIES OF THE QUALIFYING ENDOSCOPIC DIAGNOSTICS OF PANCREAS NEOPLASMS

the aim of study was testing and introduction in clinical practice combination of EUS with sonoelastography, fine-needle biopsy and needle-based confocal laser endomicroscopy in advanced diagnostic of pancreatic disease.

in the period from February 2014 to December 2015, we accumulated experience of EUS-FNA in 72 patients mostly with tumor pathology of the pancreas. In 16 cases we used 19G, in 49-22G, and in 7 patients - 25G needles. In 5 patients we used COOK Echotip Procore needle. In 8 cases we performed confocal laser endomicroscopy through the 19G needle (nCLE) in 3 patients with cystic and in 5 - with solid tumors. In 20 patients, there we used.HITA-CHI-PENTAX sonoelastography was performed.

There were no complications in EUS-FNA. In all cases we received pathology verification of disease. nCLE results always confirmed by morphological examination of material. In elastography examination normal pancreatic tissue had a equable green-yellow color, in chronic pancreatitis on the same background there were areas of blue seal parenchyma, in the cases pancreatic adenocarcinoma it was marked predominance of blue color scale, in neuroendocrine tumors - diffuse distribution of green and blue areas. Using nCLE in patients with adenocarcinoma revealed the destruction of certain glands, polymorphic nuclei of epithelial cells, with their enlargement, deformation, loss of polarity. Appliance of Procore needle has its technical features, but allowed us to obtain more material with less bloody - due to fewer number of passes.

Thus, our study confirms the effectiveness of EUS-FNA with sonoelastography and nCLE. It defines objectives for improvement and expansion of the range for their clinical use.