Transgastric ultrasonography of the pancreas

This is a report of initial experience gained with the transgastric diagnostic examination of the pancreas in a total of 80 patients. The examinations were carried out with two different instruments. One of the two fiberscopes carries on its tip a mechanical sector scanner, the scan plane of which is angulated through 90 degrees vis-a-vis the longitudinal axis of the instrument. The other ultrasonic endoscope is provided with an ultrasonic linear array assembly arranged along the longitudinal axis of the instrument. The sonic frequency is 7 and 7.5 MHz, respectively, so that the quality of resolution obtained is equal to that of a "small parts" scanner. Intubation of the stomach is readily possible with either instrument. In contrast, owing to the relatively long flexible tip of the instrument, intubation of the duodenum proved impossible in about one quarter of the patients, in particular when the duodenum was deformed by scar tissue. The topographic-anatomic orientation proved difficult, in particular since the scan planes are strictly determined by the position of the endoscope. A systematic examination of the pancreas in two planes is, as a result, virtually impossible. All in all, therefore, the technique must be considered merely as a supplementary procedure to external diagnostic ultrasonography. Thanks to its superior resolution, and the avoidance of such obstacles as "bowel gas", however, it is capable, as a supplementary examination, of providing additional diagnostic information about lesions of the pancreas.