Endoscopic ultrasonography of the pancreas

The pancreas is the most technically demanding area to image with EUS. This technique, however, has found a clinical niche in evaluating patients with pancreatic cancer to determine resectability and likely will play a prominent role in the future in diagnosis through ultrasonographically directed FNA. Its role in localization of neuroendocrine tumors is established as long as preoperative localization is important in management. It is unlikely that a competing technology will develop in the near future with resolution the same or better than EUS. The role of EUS in the evaluation of early chronic pancreatitis is still under investigation, but it is likely that it can play a role adjunctive to ERCP. If FNA can be demonstrated to be safe and the interpretation of the cytology is accurate, then EUS could play an important role in this area. In the future, EUS may be used to acutely aspirate pancreatic pseudocysts and potentially could be useful in differentiating pseudocysts amenable to endoscopic drainage versus those that would be managed best by percutaneous or surgical drainage. With some design modifications, it may be feasible in the future to use ultrasonographic guidance to puncture pseudocysts and then place nasocystic drains or internal stents. These areas will need further investigation and further technological development.