Skip to main content

Role of Endoscopic Ultrasonography in the Management of Benign Biliopancreatic Diseases

  • Chapter
  • First Online:
Biliopancreatic Endoscopy

Abstract

Pancreatic cystic disease consists of about 2.5% in individuals without history of symptoms of pancreatic disease [1, 2]. Cystic pancreatic lesions encompass a varied group of pancreatic abnormalities, including inflammatory (pseudocysts), benign (serous cystadenomas), precancerous (mucinous cystic neoplasms [MCNs], intraductal papillary mucinous neoplasms [IPMNs], and solid and pseudopapillary epithelium neoplasm), and other entities (cystic degeneration of ductal origin pancreatic cancer or neuroendocrine carcinomas) [3–7]. The serous cystadenomas (SCAs) often reveal a microcystic or honeycomb appearance on imaging with the pathognomonic central scar or sunburst calcification occurring in up to 20% of these lesions (Fig. 1). SCAs consist of cuboidal epithelial cells that stain positive for glycogen and more importantly only very rarely carry malignant potential [8]. The mucinous cystic neoplasm (MCN) of the pancreas is a relatively uncommon tumor that comprises about a quarter of all resected cystic neoplasms of the pancreas in large surgical series [9]. This tumor (Fig. 2) is predominantly seen in women (>95%) and in the distal pancreas (>95%) and, unlike branch duct IPMNs, is always a single lesion [10–12].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. de Jong K, Nio CY, Mearadji B, et al. Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas. 2012;41:278–82.

    Article  PubMed  Google Scholar 

  2. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. Am J Roentgenol. 2008;191:802–7.

    Article  Google Scholar 

  3. Kimura W, Nagai H, Esaki Y, et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18:197–206.

    CAS  PubMed  Google Scholar 

  4. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004;239:651–7. discussion, 657–659

    Article  PubMed  PubMed Central  Google Scholar 

  5. Handrich SJ, Hough DM, Sarr MG, et al. The natural history of the incidentally discovered small simple pancreatic cyst: long-term follow-up and clinical implications. Am J Roentgenol. 2005;184:20–3.

    Article  Google Scholar 

  6. Kirkpatrick ID, Desser TS, Jeffrey RB, et al. Small cystic lesions of the pancreas: clinical significance and findings at follow-up. Abdom Imaging. 2007;32:119–25.

    Article  PubMed  Google Scholar 

  7. Lahav M, Maor Y, Bar-Meir S, et al. Nonsurgical management of asymptomatic incidental pancreatic cysts. Clin Gastroenterol Hepatol. 2007;5:813–7.

    Article  PubMed  Google Scholar 

  8. Khashab MA, Shin EJ, Giday S, et al. Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms. Am J Gastroenterol. 2011;106:1521–6.

    Article  PubMed  Google Scholar 

  9. Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S4–S12.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247:571–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas. 2011;40:67–71.

    Article  CAS  PubMed  Google Scholar 

  12. Le Baleur Y, Couvelard A, Vullierme MP, et al. Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. Pancreatology. 2011;11:495–9.

    Article  PubMed  Google Scholar 

  13. Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23:410–22.

    Article  CAS  PubMed  Google Scholar 

  14. Thompson LD, Becker RC, Heffess CS, et al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999;23:1–16.

    Article  CAS  PubMed  Google Scholar 

  15. Longnecker DS, Adsay NV, Fernandez-del Castillo C, et al. Histopathological diagnosis of pancreatic intraepithelial neoplasia and intraductal papillary-mucinous neoplasms: interobserver agreement. Pancreas. 2005;31:344.

    Article  PubMed  Google Scholar 

  16. Hruban RH, Takaori K, Klimstra DS, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977.

    Article  PubMed  Google Scholar 

  17. Crippa S, Fernández-del Castillo C, Salvia R, et al. Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol. 2010;8:213–9.

    Article  PubMed  Google Scholar 

  18. Mino-Kenudson M, Fernández-del Castillo C, Baba Y, et al. Prognosis of invasive IPMN depends on histological and precursor epithelial subtypes. Gut. 2011;60:1712–20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Furukawa T, Klöppel G, Adsay NV, et al. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch. 2005;447:794–9.

    Article  PubMed  Google Scholar 

  20. Sadakari Y, Ohuchida K, Nakata K, et al. Invasive carcinoma derived from the nonintestinal type intraductal papillary mucinous neoplasm of the pancreas has a poorer prognosis than that derived from the intestinal type. Surgery. 2010;147:812–7.

    Article  PubMed  Google Scholar 

  21. Reddy S, Cameron JL, Scudiere J, et al. Surgical management of solid- pseudopapillary neoplasms of the pancreas (Franz or Hamoudi tumors): a single-institutional series. J Am Coll Surg. 2009;208:950–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Butte JM, Brennan MF, Gonen M, et al. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a signle center. J Gastrointest Surg. 2011;15:350–7.

    Article  PubMed  Google Scholar 

  23. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–61.

    Article  PubMed  Google Scholar 

  24. Amouyal P, Palazzo L, Vilgrain V, et al. Endosonography: promising method for diagnosis of extrahepatic cholestasis. Lancet. 1989;2:1195–8.

    Article  CAS  PubMed  Google Scholar 

  25. Giljaca V, Gurusamy KS, Takwoingi Y, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for the diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;(2). Art. No.: CD011549.

    Google Scholar 

  26. Palazzo L, O’Toole D. EUS in common bile duct stones. Gastrointest Endosc. 2002;56(4):S49–57.

    Article  PubMed  Google Scholar 

  27. Grimm H, Binmoeller KF, Soehendra N. Endosonography-guided drainage of a pancreatic pseudocyst. Gastrointest Endosc. 1992;38:170–1.

    Article  CAS  PubMed  Google Scholar 

  28. Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc. 1996;44:614–7.

    Article  CAS  PubMed  Google Scholar 

  29. Varadarajulu S, Bang JY, Phadnis MA, et al. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15:2080–8.

    Article  PubMed  Google Scholar 

  30. Penn DE, Draganov PV, Wagh MS, et al. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc. 2012;76:679–84.

    Article  PubMed  Google Scholar 

  31. Weilert F, Binmoeller KF, Shah JN, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy. 2012;44:780–3.

    Article  CAS  PubMed  Google Scholar 

  32. Fabbri C, Luigiano C, Maimone A, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. World J Gastrointest Endosc. 2012;4:479–88.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Raijman I, Tarnasky PR, Kahaleh M, et al. Endoscopic drainage of pancreatic fluid collections using fully covered expandable metal stent with anti-migratory fins. Endosc Ultrasound. 2015;4(3):213–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Itoi T, Binmoeller KF, Moriyasu F, et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75:870–6.

    Article  PubMed  Google Scholar 

  35. Widmer JL, Michel K. Endoscopic ultrasound-guided treatment beyond drainage: hemostasis, anastomosis, and others. Clin Endosc. 2014;47:432–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol. 2014;7:94–102.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Widmer J, Alvarez P, Kahaleh M, et al. Endoscopic ultrasonography-guided cholecystogastrostomy in patients with unresectable pancreatic cancer using anti-migratory metal stents: a new approach. Dig Endosc. 2014;26:599–602.

    Article  PubMed  Google Scholar 

  38. Jang JW, Lee SS, Yun SC, et al. Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology. 2012;142:805–11.

    Article  PubMed  Google Scholar 

  39. Choi JH, Lee SS, Kim MH, et al. Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis. Endoscopy. 2014;46:656–61.

    Article  PubMed  Google Scholar 

  40. Teoh AY, Binmoeller KF, Lau JY. Single-step EUS-guided puncture and delivery of a lumen-apposing stent for gallbladder drainage using a novel cautery-tipped stent delivery system. Gastrointest Endosc. 2014;80:1171.

    Article  PubMed  Google Scholar 

  41. Scott A, Hinwood D, Donnelly R. Radio-frequency ablation for symptom control in a patient with metastatic pancreatic insulinoma. Clin Endocrinol. 2002;56:557–9.

    Article  Google Scholar 

  42. Jurgensen C, Schuppan D, Stolzel U, et al. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63:1059–62.

    Article  PubMed  Google Scholar 

  43. Seo DW. EUS-guided antitumor therapy for pancreatic tumors. Gut Liver. 2010;4(Suppl. 1):S76–81.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44:656–62.

    Article  CAS  PubMed  Google Scholar 

  45. Levy MJ, Topazian MD, Chari ST, et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am J Gastroenterol. 2008;103:98–103.

    Article  PubMed  Google Scholar 

  46. Doi S, Yasuda I, Yamao K, et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy. 2013;45:362–9.

    Article  CAS  PubMed  Google Scholar 

  47. Wiersema MJ, Sandusky D, Carr R, et al. Endosonography-guided cholangiopancreatography. Gastrointest Endosc. 1996;43:102–6.

    Article  CAS  PubMed  Google Scholar 

  48. Shami VM, Kahaleh M. Endoscopic ultrasound-guided cholangio-pancreatography and rendezvous techniques. Dig Liver Dis. 2010;42:419–24.

    Article  PubMed  Google Scholar 

  49. Chen YI, Itoi T, Baron TH, et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc. 2017;31(7):2946–52.

    Article  PubMed  Google Scholar 

  50. Itoi T, Ishii K, Tanaka R, et al. Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos). J Hepatobiliary Pancreat Sci. 2015;22:3–11.

    Article  PubMed  Google Scholar 

  51. Itoi T, Baron TH, Mouen K, et al. Technical review of EUS-guided gastroenterostomy in 2017. Dig Endosc. 2017;29:495–502.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jiann-Hwa Chen M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chen, JH. (2018). Role of Endoscopic Ultrasonography in the Management of Benign Biliopancreatic Diseases. In: Lai, KH., Mo, LR., Wang, HP. (eds) Biliopancreatic Endoscopy. Springer, Singapore. https://doi.org/10.1007/978-981-10-4367-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4367-3_13

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4366-6

  • Online ISBN: 978-981-10-4367-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics