Endoscopic ultrasonography in the management of pancreatic disease: Versatile approaches to cancer staging, therapy, and pain control

Endoscopic ultrasonography (EUS) is a highly accurate method for staging malignancies of the pancreas. The most valuable role of EUS is identifying patients in whom pancreatic cancer is unlikely to be curable with surgical excision because of vascular invasion or regional nodal metastases. The ability to obtain tissue for histologic confirmation of the diagnosis, using EUS-guided fine-needle aspiration, is also important, even in patients who are not candidates for surgical therapy. Other indications for EUS include evaluation for chronic pancreatitis, the characterization of cystic lesions of the pancreas, and the ablation of pain using celiac plexus block or neurolysis. Recent investigations of EUS-guided fine-needle injection therapy may extend the role of this technique into palliation for patients with unresectable tumors.