[Pancreatic carcinoma--diagnosis and screening--endoscopic therapy]

Diagnosis of pancreatic carcinoma is nowadays established by means of transabdominal sonography and computed tomography. In cases remaining unclear or accompanied by obstructive jaundice ERCP is also required. Small tumours can only be detected by ERCP or endosonography with sufficient accuracy. Biopsy (percutaneous or ductal during ERCP) should be restricted to cases in which the histologic or cytologic results influence therapeutic concepts substantially. Magnetic resonance imaging and endoscopy of the pancreatic duct are currently being evaluated. Tumor markers such as CA 19-9 are mostly useful in confirming suspicious morphology; their specificity and the sensitivity in small tumours are unsatisfactory. Precise pretherapeutic staging with computed tomography, endosonography, and laparoscopy can avoid superfluous surgical procedures. Early diagnosis of pancreatic cancer appears possible at present only by means of ERCP or endosonography, but patients at risk still have to be defined since blind screening would be ineffective due to insufficient specificity, expensive and dangerous due to the complications of the applied methods. In the patient with obstructive jaundice unfit for surgery, or with metastatic spread of the disease, endoscopic stent insertion is the palliative treatment of choice. Because of longer patency metal stents are superior to plastic endoprotheses.