Endoscopic ultrasonography in benign pancreatic disease.

It seems that EUS will most likely become the gold standard technique to diagnose chronic pancreatitis not diagnosed on plain radiography, standard transcutaneous sonography, or CT scanning. Because of its low risk and increased sensitivity, it will replace ERCP as a diagnostic test for this condition. Confirmation with cytology may be beneficial for indeterminate cases. EUS will also have an important role in determining the management of cystic lesions in the pancreas. EUS seems to be very effective in determining which cystic lesions have malignant potential. If a cyst appears malignant or produces symptoms, it requires resection and therefore does not require FNA. Prediction of the clinical course for cysts of indeterminate nature requires EUS-guided FNA and analysis of fluid. EUS, although quite accurate in diagnosing CBD stones, has a more limited role in diagnosis and management of stone disease because of current limitations of therapeutic maneuvers, which can be performed at the same time. In general, patients with probable CBD stones or sludge require therapeutic ERCP. Therefore, ERCP is the preferred initial test to diagnose and simultaneously treat these disorders. Patients with a low suspicion for CBD stones, or patients with relative contraindications to ERCP (i.e., pregnancy or bleeding disorders), can be evaluated first with EUS to determine whether further invasive treatment is required. EUS seems to be complementary to therapeutic ERCP for the aspiration and drainage of cysts and pseudocysts. Although celiac plexus nerve blocks using EUS-guided injection of neurolytic agents seems to be more effective than other nerve block techniques, surgical bypass or resection is likely to continue as the primary method of treatment of patients with pain from chronic pancreatitis or those who do not respond to endoscopic stenting when there is a dominant stricture that can be bypassed.