The role of endoscopic ultrasonography in the management of cystic lesions of the pancreas

Abstract

Objective. To review the role of endoscopic ultrasonography in the management of cystic lesions of the pancreas. Data sources. MEDLINE literature search (1998-2003). Study selection. Key words for the literature search were 'endoscopic ultrasonography', 'pancreas', 'pseudocyst', and 'cystic tumor'. Data extraction. All relevant studies were reviewed. Data synthesis. In the management of cystic lesions of the pancreas, endoscopic ultrasonography appears to be superior to percutaneous ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography, because it can achieve detailed imaging of both the pancreatic parenchymal tissue and the ductal anatomy simultaneously with a high-frequency ultrasound examination at a close proximity. Endoscopic ultrasonography can differentiate benign pseudocysts or benign cystic lesions from malignant neoplasms of the pancreas; the distinction is crucial in the surgical treatment of the patients. The diagnostic accuracy can be further enhanced with endoscopic ultrasonography-guided fine-needle aspiration of the cystic fluid to detect tumour markers and cytological examination. Endoscopic ultrasonography-guided aspiration with or without endoscopic cystogastrostomy or cystoduodenostomy has become the treatment of choice for patients with pancreatic pseudocysts. The procedure is associated with decreased morbidity and mortality when compared with open surgery. Conclusion. Endoscopic ultrasonography appears to be a useful tool in the management of cystic lesions of the pancreas.