Endoscopic ultrasonography is a highly sensitive and specific procedure for the localization of pancreatic endocrine tumors. It should be considered for the preoperative localization of such tumors once the clinical and laboratory diagnosis has been established.
Endoscopic ultrasound (EUS) was performed in 37 patients with upper gastrointestinal tract submucosal tumors (SMT). Fourteen of these were located in the esophagus, 20 in the stomach, and 3 in the duodenum. In 26 patients histologic confirmation was achieved by operation (n = 15) or biopsy/puncture (n = 11). EUS was able to visualize all tumors and, with one exception, determined their originating wall layer correctly. It became evident that myogenic tumors arise from the echo-poor layers (second layer and fourth--that is, muscularis propria) and that other lesions, such as cysts or fibromas, originate from the third, echo-rich layer (submucosa). Tumor size was correctly (+/- less than 5 mm) predicted in 87% of cases. Computed tomography, performed in 22 patients, was successful in visualizing the SMT in only two-thirds of cases. No single endosonographic criterion could be obtained which enabled accurate differentiation between benign and malignant SMT. However, from a clinical point of view, it seems reasonably safe to regard smaller (less than 3 cm), smoothly demarcated SMT as benign and follow them up by repeated EUS, especially in patients at risk for surgery. Larger masses (greater than 5 cm) and those with irregular borders should be suspected of being malignant. In the future, application of new, small ultrasound probes that can be used during conventional endoscopy (two SMT were visualized successfully) may greatly simplify the procedure.
Endoscopic ultrasonography (EUS) and endoscopic retrograde pancreatography (ERP) were prospectively performed in 114 patients, 94 of whom (62 men, mean age 53 years) had inflammatory pancreatic disease, either chronic pancreatitis or status post acute edematous pancreatitis. Twenty patients (14 men, mean age 54 years) who were examined for other reasons and who had a normal ERP served as controls. EUS was performed in most cases with the knowledge of ERP results which had been classified according to the Cambridge classification system of chronic pancreatitis as being grade 0 (normal) or 1-3 (inflammatory changes). Parenchymal and ductal changes on EUS were correlated with the ERP changes. Abnormal EUS features were found in all patients with grade 2 and 3 chronic pancreatitis, in 88% with stage 1, and in 63% of cases with a normal ERP as well. These changes were, however, not detectable in any of the 20 control cases. Among the EUS features of chronic pancreatitis, diffuse changes predominated (stage 1: 75%, 2: 88%, 3: 96%) and consisted mainly of alternating echopoor and echorich areas and of a lobulated parenchymal pattern. In 80% of patients, these findings were combined with an irregular pancreatic margin. Changes of the main pancreatic duct were found in stages 2 and 3 in 81% and 96%, respectively; isolated side branch alterations, as detected mainly in stage 1 chronic pancreatitis on ERP, escaped endosonographic visualization. We conclude that EUS shows inflammatory changes in almost all patients in whom ERP suggests chronic pancreatitis. EUS, however, is also positive in a considerable number of cases with normal ERP but who have a clinical episode of pancreatic inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)
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