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EUS in Pancreatic Tumors

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ERCP and EUS

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Abstract

Endoscopic ultrasound (EUS) has assumed an increasing role in the management of pancreatic cancer over the past two decades. As a result, therapeutic endoscopists, gastroenterologists, general surgeons, and internists are expected to have a working knowledge of this technique. This chapter will provide an evidence-based approach to the use of EUS for the diagnosis of pancreatic adenocarcinoma, its staging, and determination of resectability compared to other imaging modalities. EUS features of pancreatic neoplasms other than adenocarcinoma will also be addressed, including pancreatic neuroendocrine tumors, primary pancreatic lymphoma, and metastasis to the pancreas. Lastly, therapeutic EUS procedures including celiac plexus neurolysis and emerging therapies will be discussed.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, London Health Sciences Centre-Victoria Hospital, University of Western Ontario, 800 Commissioners Road East, London, ON N6A 5W9, Canada

    Michael Sai Lai Sey MD, FRCPC

  2. Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 N. University Blvd., UH 4100, Indianapolis, IN 46202, USA

    John DeWitt MD, FASGE, FACG, FACP & Mohammad Al-Haddad MBBS, MSc, FASGE

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  1. Michael Sai Lai Sey MD, FRCPC
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  2. John DeWitt MD, FASGE, FACG, FACP
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  3. Mohammad Al-Haddad MBBS, MSc, FASGE
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Correspondence to Mohammad Al-Haddad MBBS, MSc, FASGE .

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  1. Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Linda S. Lee

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Video Caption

Video 30.1 This video demonstrates the technique of EUS-guided celiac ganglia neurolysis in a patient with chronic pain from metastatic pancreatic cancer . The EUS shows the celiac artery taking off from the aorta with an oval celiac ganglia appearing hypoechoic and mildly heterogeneous. This is labelled during EUS. Then the 22-gauge needle is advanced into the ganglia followed by aspiration to confirm the lack of blood return and injection of a combination of bupivacaine and alcohol visibly emerging from the tip of the needle

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Lai Sey, M., DeWitt, J., Al-Haddad, M. (2015). EUS in Pancreatic Tumors. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_30

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