SpringerLink
Log in

Gastroenterology and pancreatic adenocarcinoma: what the radiologist needs to know

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

In this article, we review the information that radiologists need to know regarding the endoscopic approach to the diagnosis and management of pancreatic cancer. This includes a review of the indications, techniques, and complications of endoscopic ultrasound. We also review information regarding endoscopic retrograde cholangiopancreatography, including the various biliary drainage techniques and the use of endoscopic palliation for patients with pancreatic cancer.

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

Access this article

Log in via an institution

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

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Howlader N, Noone A, Krapcho M, Miller D, Bishop K, Kosary C, et al. SEER cancer statistics review, 1975–2014. https://seer.cancer.gov/csr/1975_2014/

  2. Al-Haddad M, DeWitt J. Chapter 14—EUS in pancreatic tumors. In: Hawes RH, Fockens P, editors. Endosonography. 2nd ed. Saint Louis: W.B. Saunders; 2011. pp. 148–65. https://www.sciencedirect.com/science/article/pii/B9781437708059000145.

  3. Krishna SG, Li F, Bhattacharya A, et al. (2015) Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: a tertiary oncology center experience. Gastrointest Endosc 81(2):370–379

    Article  PubMed  Google Scholar 

  4. DeWitt J, Devereaux B, Chriswell M, et al. (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141(10):753–763

    Article  PubMed  Google Scholar 

  5. Dewitt J, Devereaux BM, Lehman GA, Sherman S, Imperiale TF (2006) Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol 4(6):717–725 (Quiz 664)

    Article  PubMed  Google Scholar 

  6. Tamm EP, Balachandran A, Bhosale PR, et al. (2012) Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin N Am 50(3):407–428

    Article  PubMed  Google Scholar 

  7. Canto MI, Harinck F, Hruban RH, et al. (2013) International cancer of the pancreas screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 62(3):339–347

    Article  PubMed  Google Scholar 

  8. Catanzaro A, Richardson S, Veloso H, et al. (2003) Long-term follow-up of patients with clinically indeterminate suspicion of pancreatic cancer and normal EUS. Gastrointest Endosc 58(6):836–840

    Article  PubMed  Google Scholar 

  9. Klapman JB, Chang KJ, Lee JG, Nguyen P (2005) Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 100(12):2658–2661

    Article  PubMed  Google Scholar 

  10. Bhutani MS, Gress FG, Giovannini M, et al. (2004) The no endosonographic detection of tumor (NEST) study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy 36(5):385–389

    Article  CAS  PubMed  Google Scholar 

  11. Krishna SG, Bhattacharya A, Li F, et al. (2016) Diagnostic differentiation of pancreatic neuroendocrine tumor from other neoplastic solid pancreatic lesions during endoscopic ultrasound-guided fine-needle aspiration. Pancreas 45(3):394–400

    Article  CAS  PubMed  Google Scholar 

  12. Krishna SG, Bhattacharya A, Ross WA, et al. (2015) Pretest prediction and diagnosis of metastatic lesions to the pancreas by endoscopic ultrasound-guided fine needle aspiration. J Gastroenterol Hepatol 30(10):1552–1560

    Article  PubMed  Google Scholar 

  13. Dumonceau J-M, Deprez P, Jenssen C, et al. (2017) Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline—Updated January 2017. Endoscopy 49(07):695–714

    Article  PubMed  Google Scholar 

  14. Mei M, Ni J, Liu D, ** P, Sun L (2013) EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis. Gastrointest Endosc 77(4):578–589

    Article  PubMed  Google Scholar 

  15. Săftoiu A, Vilmann P, Ciurea T, et al. (2007) Dynamic analysis of EUS used for the differentiation of benign and malignant lymph nodes. Gastrointest Endosc 66(2):291–300

    Article  PubMed  Google Scholar 

  16. Xu W, Shi J, Zeng X, et al. (2011) EUS elastography for the differentiation of benign and malignant lymph nodes: a meta-analysis. Gastrointest Endosc 74(5):1001–1009

    Article  PubMed  Google Scholar 

  17. Săftoiu A, Vilmann P (2013) Differential diagnosis of focal pancreatic masses by semiquantitative EUS elastography: between strain ratios and strain histograms. Gastrointest Endosc 78(1):188–189

    Article  PubMed  Google Scholar 

  18. Dawwas MF, Taha H, Leeds JS, Nayar MK, Oppong KW (2012) Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: a prospective, single-center study. Gastrointest Endosc 76(5):953–961

    Article  PubMed  Google Scholar 

  19. Dietrich CF, Ignee A, Braden B, et al. (2008) Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound. Clin Gastroenterol Hepatol 6(5):590.e1–597.e1

    Article  Google Scholar 

  20. Fogel EL, Shahda S, Sandrasegaran K, et al. (2017) A multidisciplinary approach to pancreas cancer in 2016: a review. Am J Gastroenterol 112(4):537–554

    Article  PubMed  PubMed Central  Google Scholar 

  21. Soriano A, Castells A, Ayuso C, et al. (2004) Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99(3):492–501

    Article  PubMed  Google Scholar 

  22. Krishna SG, Rao BB, Ugbarugba E, et al. (2017) Diagnostic performance of endoscopic ultrasound for detection of pancreatic malignancy following an indeterminate multidetector CT scan: a systemic review and meta-analysis. Surg Endosc. doi:10.1007/s00464-017-5516-y

    Google Scholar 

  23. DeWitt J, LeBlanc J, McHenry L, McGreevy K, Sherman S (2007) Endoscopic ultrasound-guided fine-needle aspiration of ascites. Clin Gastroenterol Hepatol 5(5):609–615

    Article  PubMed  Google Scholar 

  24. DeWitt J, LeBlanc J, McHenry L, et al. (2003) Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single-center experience. Am J Gastroenterol 98(9):1976–1981

    PubMed  Google Scholar 

  25. Wang K-X, Ben Q-W, ** Z-D, et al. (2011) Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 73(2):283–290

    Article  PubMed  Google Scholar 

  26. Coté GA, Sherman S (2012) Endoscopic palliation of pancreatic cancer. Cancer J Sudbury Mass 18(6):584–590

    Article  Google Scholar 

  27. Wagh MS, de Bellis M, Fogel EL, et al. (2013) Multicenter randomized trial of 10-French versus 11.5-French plastic stents for malignant biliary obstruction. Diagn Ther Endosc 2013:891915

    PubMed  PubMed Central  Google Scholar 

  28. Dumonceau J-M, Tringali A, Blero D, et al. (2012) Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 44(3):277–298

    Article  PubMed  Google Scholar 

  29. van Berkel AM, Bruno MJ, Bergman JJGHM, et al. (2003) A prospective randomized study of hydrophilic polymer-coated polyurethane versus polyethylene stents in distal malignant biliary obstruction. Endoscopy 35(6):478–482

    Article  PubMed  Google Scholar 

  30. Moss AC, Morris E, Macmathuna P (2006) Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 19(2):CD004200

    Google Scholar 

  31. Schmassmann A, von Gunten E, Knuchel J, et al. (1996) Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 91(4):654–659

    CAS  PubMed  Google Scholar 

  32. Yeoh KG, Zimmerman MJ, Cunningham JT, Cotton PB (1999) Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 49(4 Pt 1):466–471

    Article  CAS  PubMed  Google Scholar 

  33. Walter D, van Boeckel PGA, Groenen MJ, et al. (2015) Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial. Gastroenterology 149(1):130–138

    Article  PubMed  Google Scholar 

  34. Saleem A, Leggett CL, Murad MH, Baron TH (2011) Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc 74(2):321.e1-3–327.e1-3

    Article  Google Scholar 

  35. Kitano M, Yamashita Y, Tanaka K, et al. (2013) Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol 108(11):1713–1722

    Article  PubMed  Google Scholar 

  36. Almadi MA, Barkun AN, Martel M (2013) No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol 11(1):27.e1–37.e1

    Article  Google Scholar 

  37. Khashab MA, Valeshabad AK, Modayil R, et al. (2013) EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 78(5):734–741

    Article  PubMed  Google Scholar 

  38. Khashab MA, Valeshabad AK, Afghani E, et al. (2015) A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 60(2):557–565

    Article  PubMed  Google Scholar 

  39. Kawakubo K, Isayama H, Kato H, et al. (2014) Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepato-Biliary-Pancreat Sci 21(5):328–334

    Article  Google Scholar 

  40. Boulay BR, Parepally M (2014) Managing malignant biliary obstruction in pancreas cancer: choosing the appropriate strategy. World J Gastroenterol 20(28):9345–9353

    PubMed  PubMed Central  Google Scholar 

  41. Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV (2011) Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol 29(26):3541–3546

    Article  PubMed  Google Scholar 

  42. Jeurnink SM, Steyerberg EW, van Hooft JE, et al. (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71(3):490–499

    Article  PubMed  Google Scholar 

  43. Perez-Miranda M, Tyberg A, Poletto D, et al. (2017) EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol. doi:10.1097/MCG.0000000000000887

    Google Scholar 

  44. Chen Y-I, Itoi T, Baron TH, et al. (2017) EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 31(7):2946–2952

    Article  PubMed  Google Scholar 

  45. Doi S, Yasuda I, Kawakami H, et al. (2013) Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy 45(5):362–369

    Article  CAS  PubMed  Google Scholar 

  46. Chahal P, Baron TH, Topazian MD, et al. (2006) Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 38(12):1241–1245

    Article  CAS  PubMed  Google Scholar 

  47. Simmons DT, Baron TH, LeRoy A, Petersen BT (2008) Percutaneous pancreatography for treatment of complicated pancreatic duct strictures. Pancreatology 8(2):194–198

    Article  PubMed  Google Scholar 

  48. Yamauchi FI, Ortega CD, Blasbalg R, et al. (2012) Multidetector CT evaluation of the postoperative pancreas. Radiographics 32(3):743–764

    Article  PubMed  Google Scholar 

  49. Shami VM, Kahaleh M (2010) Endoscopic ultrasound-guided cholangiopancreatography and rendezvous techniques. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 42(6):419–424

    Google Scholar 

  50. Levy MJ, Chari S, Adler DG, et al. (2004) Complications of temporary pancreatic stent insertion for pancreaticojejunal anastomosis during pancreaticoduodenectomy. Gastrointest Endosc 59(6):719–724

    Article  PubMed  Google Scholar 

  51. Layec S, D’Halluin P-N, Pagenault M, et al. (2010) Removal of transanastomotic pancreatic stent tubes after pancreaticoduodenectomy: a new role for double-balloon enteroscopy. Gastrointest Endosc 72(2):449–451

    Article  PubMed  Google Scholar 

  52. Bassi C, Marchegiani G, Dervenis C, et al. (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    Article  PubMed  Google Scholar 

  53. Goh BKP, Tan Y-M, Chung Y-FA, et al. (2008) Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 143(10):956–965

    Article  PubMed  Google Scholar 

  54. Saeed ZA, Ramirez FC, Hepps KS (1993) Endoscopic stent placement for internal and external pancreatic fistulas. Gastroenterology 105(4):1213–1217

    Article  CAS  PubMed  Google Scholar 

  55. Grobmyer SR, Hunt DL, Forsmark CE, et al. (2009) Pancreatic stent placement is associated with resolution of refractory grade C pancreatic fistula after left-sided pancreatectomy. Am Surg 75(8):654–657 (Discussion 657–658)

    PubMed  PubMed Central  Google Scholar 

  56. Goasguen N, Bourrier A, Ponsot P, et al. (2009) Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation. Am J Surg 197(6):715–720

    Article  PubMed  Google Scholar 

  57. Varadarajulu S, Wilcox CM, Christein JD (2011) EUS-guided therapy for management of peripancreatic fluid collections after distal pancreatectomy in 20 consecutive patients. Gastrointest Endosc 74(2):418–423

    Article  PubMed  Google Scholar 

  58. Azeem N, Baron TH, Topazian MD, et al. (2012) Outcomes of endoscopic and percutaneous drainage of pancreatic fluid collections arising after pancreatic tail resection. J Am Coll Surg 215(2):177–185

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    Abhik Bhattacharya & Prabhleen Chahal

  2. Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Namita S. Gandhi & Mark E. Baker

Authors
  1. Abhik Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Namita S. Gandhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark E. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prabhleen Chahal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Namita S. Gandhi.

Ethics declarations

Funding

This article was not part of any funded grant.

Conflict of interest

None of the authors have any conflict of interest related to this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhattacharya, A., Gandhi, N.S., Baker, M.E. et al. Gastroenterology and pancreatic adenocarcinoma: what the radiologist needs to know. Abdom Radiol 43, 364–373 (2018). https://doi.org/10.1007/s00261-017-1347-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1347-5

Keywords

Search

Navigation