title: Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease.
abstract: Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases. Furthermore, as EUS technology has advanced, it has increasingly become a therapeutic procedure, and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon. However, this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice. In particular, the diagnostic evaluation of acute pancreatitis, chronic pancreatitis, cystic pancreatic lesions and solid masses of the pancreas are discussed. The newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this context. The main therapeutic aspects of pancreatic EUS are then considered, namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer, and EUS-guided drainage of pancreatic fluid collections.
authors.affiliation: Christopher W Teshima, Gurpal S Sandha, Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Teshima
authors.affiliation: Christopher W Teshima, Gurpal S Sandha, Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada.
authors.forename: Gurpal S
authors.initials: GS
authors.lastname: Sandha
mesh_terms: D004322:Drainage / Q000379:methods*; D019160:Endosonography; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Endoscopic ultrasonography; Fine needle aspiration; Pancreatic cyst; Pancreatic neoplasms; Pancreatitis
references.citation: Pancreas. 2011 Mar;40(2):289-94
references.pmid: 21206330
references.citation: Gastroenterology. 2004 May;126(5):1330-6
references.pmid: 15131794
references.citation: Dig Dis Sci. 2009 Nov;54(11):2330-7
references.pmid: 19137428
references.citation: Gastrointest Endosc. 2009 Jun;69(7):1251-61
references.pmid: 19243769
references.citation: J Gastroenterol. 2011 Jun;46(6):843-53
references.pmid: 21505859
references.citation: Gastroenterology. 2013 Jun;144(6):1272-81
references.pmid: 23622137
references.citation: Gastrointest Endosc Clin N Am. 2012 Apr;22(2):333-48, x-xi
references.pmid: 22632955
references.citation: Gastrointest Endosc. 2010 Mar;71(3):519-26
references.pmid: 20189510
references.citation: J Clin Ultrasound. 2009 Jan;37(1):1-17
references.pmid: 18932265
references.citation: Gastrointest Endosc. 1997 May;45(5):387-93
references.pmid: 9165320
references.citation: AJR Am J Roentgenol. 2008 Sep;191(3):802-7
references.pmid: 18716113
references.citation: Br J Surg. 2009 Sep;96(9):967-74
references.pmid: 19644975
references.citation: Cancer. 2003 Oct 25;99(5):285-92
references.pmid: 14579295
references.citation: Gut. 2013 Jan;62(1):102-11
references.pmid: 23100216
references.citation: Gastrointest Endosc. 2013 May;77(5):809-14
references.pmid: 23453183
references.citation: Gastrointest Endosc. 2013 May;77(5):739-44
references.pmid: 23369651
references.citation: Gastrointest Endosc. 2011 Sep;74(3):504-10
references.pmid: 21872709
references.citation: Am J Gastroenterol. 2011 Sep;106(9):1705-10
references.pmid: 21483464
references.citation: Clin Gastroenterol Hepatol. 2009 Jan;7(1):114-9
references.pmid: 18955165
references.citation: Gastrointest Endosc. 2010 Jun;71(7):1280-9
references.pmid: 20598255
references.citation: Eur J Gastroenterol Hepatol. 2011 May;23(5):367-74
references.pmid: 21487299
references.citation: JAMA. 2012 Mar 14;307(10):1053-61
references.pmid: 22416101
references.citation: Endoscopy. 2010 Jul;42(7):564-70
references.pmid: 20593334
references.citation: Am J Gastroenterol. 2007 Feb;102(2):430-8
references.pmid: 17100960
references.citation: Gastroenterol Clin North Am. 2012 Mar;41(1):179-88
references.pmid: 22341257
references.citation: Gastrointest Endosc. 2007 Sep;66(3):501-9
references.pmid: 17640639
references.citation: J Clin Oncol. 2011 Sep 10;29(26):3541-6
references.pmid: 21844506
references.citation: Gastroenterology. 1997 Apr;112(4):1087-95
references.pmid: 9097990
references.citation: Gastrointest Endosc Clin N Am. 2013 Oct;23(4):787-802
references.pmid: 24079790
references.citation: World J Gastroenterol. 2009 Apr 7;15(13):1587-93
references.pmid: 19340900
references.citation: Endoscopy. 2013 Oct;45(10):781-8
references.pmid: 24019131
references.citation: Gastrointest Endosc. 2005 Nov;62(5):728-36; quiz 751, 753
references.pmid: 16246688
references.citation: Gastrointest Endosc. 2013 Apr;77(4):578-89
references.pmid: 23199646
references.citation: Endoscopy. 1995 Feb;27(2):171-7
references.pmid: 7601050
references.citation: Endoscopy. 2013 Aug;45(8):627-34
references.pmid: 23807806
references.citation: Clin Gastroenterol Hepatol. 2012 Jan;10(1):84-90.e1
references.pmid: 21963957
references.citation: Clin Gastroenterol Hepatol. 2012 Mar;10(3):316-22
references.pmid: 22019795
references.citation: Gastrointest Endosc. 2012 Dec;76(6):1214-23
references.pmid: 23040609
references.citation: Gastrointest Endosc. 2012 Sep;76(3):594-602
references.pmid: 22898417
references.citation: Gastrointest Endosc. 2009 Dec;70(6):1101-8
references.pmid: 19647248
references.citation: Endoscopy. 2013 Jun;45(6):445-50
references.pmid: 23504490
references.citation: Gastroenterology. 2013 Sep;145(3):583-90.e1
references.pmid: 23732774
references.citation: Gastrointest Endosc. 2012 Aug;76(2):301-9
references.pmid: 22703697
references.citation: Gastrointest Endosc. 2007 Jun;65(7):971-8
references.pmid: 17531630
references.citation: J Gastrointest Surg. 2011 Nov;15(11):2080-8
references.pmid: 21786063
references.citation: Clin Gastroenterol Hepatol. 2012 Jul;10(7):697-703
references.pmid: 22475740
references.citation: Gastrointest Endosc. 1996 Dec;44(6):656-62
references.pmid: 8979053
references.citation: Am J Gastroenterol. 2005 Dec;100(12):2658-61
references.pmid: 16393216
references.citation: Gastrointest Endosc. 2009 Jun;69(7):1264-70
references.pmid: 19243768
references.citation: Gastrointest Endosc. 2013 May;77(5):745-51
references.pmid: 23433878
references.citation: Gastrointest Endosc. 2011 Dec;74(6):1408-12
references.pmid: 21981812
references.citation: Pancreas. 2011 Oct;40(7):1073-9
references.pmid: 21633317
references.citation: Endoscopy. 2013;45(2):86-92
references.pmid: 23307148
references.citation: Endoscopy. 2013;45(5):362-9
references.pmid: 23616126
references.citation: Scand J Gastroenterol. 2012 Jul;47(7):853-60
references.pmid: 22507131
references.citation: Clin Gastroenterol Hepatol. 2008 May;6(5):590-597.e1
references.pmid: 18455699
references.citation: Gastrointest Endosc. 2011 Jul;74(1):74-80
references.pmid: 21612778
references.citation: Can J Gastroenterol. 2011 May;25(5):261-4
references.pmid: 21647460
references.citation: JAMA. 2004 Mar 3;291(9):1092-9
references.pmid: 14996778
references.citation: World J Gastroenterol. 2007 Dec 7;13(45):5963-70
references.pmid: 18023084
references.citation: Gastrointest Endosc. 2011 Apr;73(4):718-26
references.pmid: 21237454
references.citation: Am J Gastroenterol. 2012 Feb;107(2):303-10
references.pmid: 22008892
references.citation: Gut. 2008 Mar;57(3):339-43
references.pmid: 17660227
references.citation: Gastrointest Endosc. 2008 Jan;67(1):141-50
references.pmid: 18155437
references.citation: Endoscopy. 2011 Jul;43(7):585-90
references.pmid: 21611945
references.citation: Am J Gastroenterol. 2006 Aug;101(8):1787-91
references.pmid: 16780554
references.citation: Br J Surg. 2003 Oct;90(10):1244-9
references.pmid: 14515294
references.citation: Clin Gastroenterol Hepatol. 2011 Aug;9(8):635-48
references.pmid: 21397725
references.citation: Endoscopy. 1997 Nov;29(9):854-8
references.pmid: 9476770
references.citation: Am J Gastroenterol. 2009 Feb;104(2):326-9
references.pmid: 19174816
references.citation: Gastrointest Endosc. 2009 May;69(6):1095-102
references.pmid: 19152896
references.citation: Cancer. 1987 Feb 15;59(4):850-6
references.pmid: 3802043
references.citation: Radiol Clin North Am. 2012 May;50(3):429-45
references.pmid: 22560690
references.citation: J Clin Gastroenterol. 2010 Feb;44(2):127-34
references.pmid: 19826273
references.citation: Gastrointest Endosc. 2012 Apr;75(4):870-6
references.pmid: 22301347
references.citation: Endoscopy. 2003 May;35(5):411-5
references.pmid: 12701013
references.citation: N Engl J Med. 2010 Apr 22;362(16):1491-502
references.pmid: 20410514
references.citation: Pancreatology. 2012 May-Jun;12(3):284-7
references.pmid: 22687386
references.citation: Gastrointest Endosc. 2013 Apr;77(4):526-33
references.pmid: 23321339
references.citation: Gastrointest Endosc. 2004 Apr;59(4):475-81
references.pmid: 15044881
references.citation: Eur J Surg Oncol. 1990 Feb;16(1):1-6
references.pmid: 1689676
references.citation: Endoscopy. 2008 Nov;40(11):910-7
references.pmid: 19009483
references.citation: Ann Surg. 2008 Apr;247(4):571-9
references.pmid: 18362619
references.citation: Dig Dis Sci. 2012 Jan;57(1):170-4
references.pmid: 21761168
references.citation: Gut. 2009 Sep;58(9):1260-6
references.pmid: 19282306
references.citation: Gastrointest Endosc Clin N Am. 2012 Apr;22(2):349-58, xi
references.pmid: 22632956
references.citation: Gastrointest Endosc. 2013 Jun;77(6):909-15
references.pmid: 23433596
references.citation: Gut. 2000 Feb;46(2):244-9
references.pmid: 10644320
references.citation: Pancreatology. 2012 May-Jun;12(3):183-97
references.pmid: 22687371
references.citation: Ann Surg. 2007 Oct;246(4):644-51; discussion 651-4
references.pmid: 17893501
references.citation: Pancreas. 2012 Nov;41(8):1176-94
references.pmid: 23086243
references.citation: Am J Gastroenterol. 2010 Sep;105(9):2079-84
references.pmid: 20354507
references.citation: Clin Gastroenterol Hepatol. 2010 Sep;8(9):806-11
references.pmid: 20621679
references.citation: Endoscopy. 2011 Jul;43(7):596-603
references.pmid: 21437851
references.citation: Endoscopy. 2009 Oct;41(10):842-8
references.pmid: 19798610
references.citation: Am J Gastroenterol. 2002 Nov;97(11):2768-75
references.pmid: 12425546
references.citation: J Gastrointest Surg. 2011 Feb;15(2):350-7
references.pmid: 20824369
references.citation: Clin Gastroenterol Hepatol. 2012 Nov;10(11):1190-201
references.pmid: 22610008
references.citation: Gastrointest Endosc. 2008 Feb;67(2):235-44
references.pmid: 18226685
references.citation: Gastrointest Endosc. 2013 Jun;77(6):839-43
references.pmid: 23684089
references.citation: Can J Gastroenterol. 2009 Jan;23(1):26-30
references.pmid: 19172205
references.citation: Endoscopy. 2004 Aug;36(8):705-9
references.pmid: 15280976
references.citation: Endoscopy. 2013 Oct;45(10):792-8
references.pmid: 24068588
references.citation: Clin Gastroenterol Hepatol. 2010 Jul;8(7):629-34.e1-2
references.pmid: 20417721
references.citation: Gastrointest Endosc. 2008 Dec;68(6):1102-11
references.pmid: 18640677
references.citation: Endoscopy. 2009 Nov;41(11):979-87
references.pmid: 19866396
references.citation: Ann Surg. 2004 May;239(5):678-85; discussion 685-7
references.pmid: 15082972
references.citation: Gastrointest Endosc. 1994 Jan-Feb;40(1):112
references.pmid: 8163115
references.citation: Pancreas. 2013 Apr;42(3):436-41
references.pmid: 23211370
references.citation: J Gastroenterol Hepatol. 2011 Oct;26(10):1500-3
references.pmid: 21521366
references.citation: Gastroenterology. 2010 Oct;139(4):1172-80
references.pmid: 20600020
references.citation: Dig Liver Dis. 2009 Oct;41(10):753-8
references.pmid: 19278909
references.citation: Gastrointest Endosc. 2009 Feb;69(2 Suppl):S71-7
references.pmid: 19179175
references.citation: Gastrointest Endosc. 2011 Jun;73(6):1189-96
references.pmid: 21420083
references.citation: Gastroenterol Clin North Am. 2012 Mar;41(1):103-18
references.pmid: 22341252
references.citation: Clin Gastroenterol Hepatol. 2013 Aug;11(8):913-21; quiz e59-60
references.pmid: 23416279
references.citation: Am J Gastroenterol. 2003 Jun;98(6):1289-94
references.pmid: 12818271
references.citation: Dig Dis Sci. 2007 May;52(5):1206-10
references.pmid: 17387611
references.citation: World J Gastroenterol. 2010 Jun 21;16(23):2841-50
references.pmid: 20556829