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THE IMPACT OF EUS ON THE DIAGNOSIS, STAGING, HISTOLOGICAL PROOF, AND TREATMENT OF COMPLICATIONS OF SOLID PANCREATIC TUMORS: A SINGLE-CENTER SERIES

Ismail QARCH 1, Mohamed Borahma 2, Nawal Lagdali 2, Maryeme Kadiri 2, Camelia Berhili 2, FATIMA-ZAHRA CHABIB 2, Fatima Zahra Ajana 3

Affiliations

1 Mohammed V university, Rabat, Morocco

2 Mohammed the Vth University, Ibn Sina Hospital, Rabat, Morocco

3 CHU IBN SINA, Rabat, Morocco

Summary

AI Generated

A retrospective study of 86 patients over 5 years found that endoscopic ultrasound detected pancreatic masses in 98.9% of cases and determined vascular invasion in 90.7%, while EUS-guided biopsy provided conclusive histological diagnosis in 65.4% of cases.

Among 115 patients with clinical suspicion of solid pancreatic tumors, 86 underwent EUS and pancreatic masses were detected in 98.9% (85 patients), with 75.5% located in the pancreatic head.
EUS determined vascular invasion in 90.7% of cases, including portal trunk and superior mesenteric vein invasion in 55.1%, celiac trunk and superior mesenteric artery invasion in 39.9%, and locoregional lymph node extension in 15.4%.
EUS-guided cytopuncture was performed in 70 cases with conclusive results in 65.4%, identifying adenocarcinoma in 94.1% of conclusive cases.
Therapeutic EUS procedures included celiac plexus block for pain management in 2 cases, neurolysis in 1 case, and anterograde biliary drainage in 5 cases after failed retrograde approach.
This material would be relevant for gastroenterologists and oncologists involved in pancreatic cancer diagnosis, staging, and interventional management.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The sensitivity of endoscopic ultrasound (EUS) in detecting pancreatic tumors exceeds 90% and can detect tumors with a diameter of less than 2 cm. EUS plays an important role in the management of patients with pancreatic cancer, providing precise diagnosis, determining local-regional extension and resectability assessment, conducting biopsies, and managing complications.
The objective of our study was to specify the impact of EUS on the diagnosis, staging, histological proof, and treatment of complications of solid pancreatic tumors.

Aims & Methods

A retrospective study was conducted over 5 years (2019-2024), including all patients admitted with clinical suspicion of solid pancreatic tumors and who experienced EUS.

Results

Out of the 115 patients admitted with clinical suspicion of pancreatic tumor, 86 (74.8%) had undergone EUS. The mean age was 68.2 years, ranging from 30 to 90 years, with a clear male predominance (sex ratio 1.1).
Biological assessment showed cholangitis grade I and grade II in 35.6% (n=31) of cases, and grade III in 4 patients (4.6%).
EUS revealed a pancreatic mass in 98.9% (n=85) of cases, with 75.5% (n=64) in the head, 14% (n=12) in the uncinate process, 7% (n=6) in the body, and 3.5% (n=3) in the neck. The size was over 3 cm in 59 cases (69.4%), between 2-3 cm in 23 cases (27.1%), and less than 2 cm in 3 cases (3.5%). double duct dilation was shown in 57 cases (66.3%), isolated bile duct dilation in 31 cases (36%), and isolated Wirsung duct dilation in 4 cases (4.6%). Pancreatic atrophy was observed in 31.4% (n=27) of cases.
EUS allowed the determination of vascular invasion in 78 cases (90.7%), invasion of the portal trunk (TP) and superior mesenteric vein (SMV) was present in 43 cases (55.1%), with invasion over >180 in 28 cases (35.9%) and <180 in 15 cases (19.2%), thrombosis in 3 cases (3.5%), and absence of invasion in 15 cases (19.2%). Invasion of the celiac trunk (CT) and superior mesenteric artery (SMA) was present in 31 cases (39.9%), with invasion over >180 in 22 cases (28.2%) and <180 in 9 cases (11.6%), thrombosis in 2 cases (2.3%), and absence of invasion in 24 cases (30.7%). Invasion of the common hepatic artery (CHA) was present in 6 cases (7.7%), with invasion over >180 in 5 cases (83.3%) and <180 in one case (16.7%), and absence of invasion in 6 cases (7.7%).
Locoregional lymph node extension was observed in 12 cases (15.4%), invasion of the common bile duct (CBD) in one case (1.3%), duodenal invasion in 3 cases (3.9%), secondary hepatic localization in 7 cases (9%), and peritoneal in 2 cases (2.6%).
Cytopuncture under EUS was performed in 70 cases (89.7%), the results of which were conclusive in 65.4% (n=51) of cases and inconclusive in 24.6% (n=19). The histological type was adenocarcinoma in 48 cases (94.1%), clear cell carcinoma, squamous cell carcinoma, and neuroendocrine tumor in one case (1.9%).
Therapeutically, EUS allowed the treatment of pancreatic abdominal pain resistant to medical treatment by celiac plexus block in 2 cases, neurolysis in one case, and also performing anterograde hepatic gastric biliary drainage after the failure of retrograde drainage due to duodenal strictures in 5 cases.

Conclusion

EUS reveals pancreatic tumors in 98.9% of cases, with its main importance lying in locoregional staging, where vascular invasion was correctly determined in 90.7% of cases, and lymph node extension in 15.4%. The value of EUS lies in determining histological type (65.4%), as well as therapeutic aspects such as pain management and biliary drainage.

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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