Endoscopic ultrasonography in staging local resectability of pancreatic and periampullary malignancy

Endoscopic ultrasonography (EUS) was performed before surgery in 14 patients with pancreatic cancer and in 9 patients with periampullary carcinoma. EUS enabled accurate determination of the extent of the lesions and the presence of suspicious lymph node enlargements. Carcinoma deeply infiltrating into the surrounding structures and major blood vessels was strongly indicative of local non-resectability. In contrast, clearly defined well-circumscribed hypoechoic tumours with no evidence of distant lymph node involvement were compatible with local resectability. The presence of multiple enlarged lymph nodes with irregular echo pattern adjacent to the major blood vessels (hepatic artery, coeliac trunk, aorta) surrounding locally resectable tumours was indicative of the palliative nature of the resection. Technical improvement, in particular the possibility of guided cytological aspiration, may further enhance the diagnostic value of this new imaging technique.