Efficacy and safety of pancreatic juice cytology by using synthetic secretin in the diagnosis of pancreatic ductal adenocarcinoma

Abstract

Adding synthetic secretin to PJC is useful for cases in which it is difficult to carry out EUS-FNA for PDAC.

Endoscopic retrograde cholangiopancreatography guided interventions in the management of pancreatic cancer

“…ENPD was first implemented by Endo et al[ 64 ] in 1974 for cytodiagnosis of pancreatic cancer. A slight modification of the standard ENPD technique wherein pancreatic juice collection is performed after injection of synthetic secretin, has been shown to provide a dedicated sample with a sufficient number of cells for cytological analysis and has improved the diagnostic sensitivity from 50.9% to 70.4%[ 65 ]. Of note, in this study, an additional 13 pancreatic cancer patients were diagnosed using the modified ENPD technique that were missed with EUS-fine needle aspiration (EUS-FNA), making the modified ENPD technique preferred, particularly in instances where tissue collection with EUS-FNA is unsuccessful or impossible[ 65 ].…”

“…A slight modification of the standard ENPD technique wherein pancreatic juice collection is performed after injection of synthetic secretin, has been shown to provide a dedicated sample with a sufficient number of cells for cytological analysis and has improved the diagnostic sensitivity from 50.9% to 70.4%[ 65 ]. Of note, in this study, an additional 13 pancreatic cancer patients were diagnosed using the modified ENPD technique that were missed with EUS-fine needle aspiration (EUS-FNA), making the modified ENPD technique preferred, particularly in instances where tissue collection with EUS-FNA is unsuccessful or impossible[ 65 ]. Another modification of ENPD involving placement of a 4 or 5 Fr tube (with 8-12 hole) in the main pancreatic duct and collection of pancreatic juice 2-6 times daily for up to 3 d has increased the diagnostic yield for detection of pancreatic cancer with 80% sensitivity, 100% specificity, 100% positive predictive value, 71% negative predictive value, and 87% overall accuracy[ 66 ].…”

“…In contrast, for stage I pancreatic cancer, EUS-FNA has been shown to be superior to ENPD (84% vs 60%)[ 69 ]. Post-ENPD pancreatitis and cholangitis are the commonly reported complications[ 65 ].…”

Value of endoscopy for early diagnosis of pancreatic carcinoma

“…25,26 These low values are attributed to difficulties associated with collecting a sufficient number of cells. Takeda et al 27 reported sensitivity of pancreas juice cytology by using synthetic secretin for pancreatic carcinoma improved from 50.9% to 70.4% compared to conventional method, and this method revealed 13 pancreatic carcinoma that had not been able to be diagnosed with EUS-FNA. In another report, Mikata et al 8 reported the use of 5-Fr or 6-Fr ENPD tubes placed in the pancreatic duct and retained for up to 3 days.…”

Endoscopic ultrasound-guided fine-needle aspiration biopsy - Recent topics and technical tips

“…Previous reports state that EUS-FNA has a sensitivity of approximately 85%-89% for pancreatic disease[23], 25%-100% for biliary duct disease[33-36], and a diagnostic power of 85.7% to 86.0% for SEL[37,38]. Techniques that are reportedly useful for supplementing this diagnostic power include pancreatic juice cytology for pancreatic disease[39-41], transpapillary bile duct biopsy, and bile cytology for biliary tract disease[42-44], and EUS-FNA with a forward-viewing linear echoendoscope for SEL[45], as well as endoscopic submucosal dissection and endoscopic snare resection[46-49].…”