Role of endoscopic ultrasound in the management of pancreatic lesions

Endoscopic ultrasound and multislice CT have shown similar sensitivities and specificities with regard to detection of most pancreatic lesions, but when pancreatic lesions are less than 2 cm EUS has a more superior detection capability. EUS is extremely useful at identifying lesions in patients with increased plasma Ca 19-9 levels and pancreatic duct dilatation, where a CT scan has failed to localize a lesion. Our own experience of highvolume EUS (>600/year) combined with multislice CT as part of our staging protocol has suggested that one method alone is not sufficient to indicate non-resectability. Our own practice is that if only one method indicates locally non-resectable tumour we will still proceed to a trial of dissection. Should they both indicate non-resectability then they are invariably correct.