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Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 123-130

Pancreatic cystic lesions: The value of contrast-enhanced endoscopic ultrasound to influence the clinical pathway

1 Klinikum Meiningen GmbH, Bergstrasse 3, D-98617 Meiningen, Germany
2 Caritas Krankenhaus Bad Mergentheim, Uhlandstraße 7, D-97980 Bad Mergentheim, Germany
3 University of Muenster, D-48143 Muenster, Germany

Correspondence Address:
Michael Hocke
Klinikum Meiningen GmbH, Bergstrasse 3, D-98617 Meiningen
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.131040

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Background and Objectives: Cystic pancreatic lesions are a growing diagnostic challenge. The aim of this study was to proof a new diagnostic concept based on contrast-enhanced endoscopic ultrasound (CE-EUS) for differential diagnosis. Patients and Methods: A total of 125 patients with unclear cystic pancreatic lesions were included. The initial diagnostic was made by CE-EUS dividing the lesions in a group without contrast enhancing effect in the cystic wall, septae or nodule indicating pseudocysts or dysontogenetic cysts and a group with contrast enhancing effect in the described structures indicating cystic neoplasias. The investigations were performed using a Pentax echoendoscope and Hitachi Preirus ultrasound machine. The contrast enhancer used was 4.8 mL SonoVue ® (Bracco, Italy). The group with suspected cystic neoplasia was referred for endoscopic fine-needle puncture for further diagnostic or treatment decisions. Results: The dividing of the groups by contrast-enhanced ultrasound was feasible because all (n = 56) suspected cystic neoplasias showed a contrast enhancing effect, whereas in only 4 from 69 pseudocystic or dysontogenetic cystic lesions a contrast enhancing effect in the wall could be observed. Endoscopic fine-needle puncture could diagnose all malignant neoplasias and relevant premalignant conditions. The long-term follow-up did not show any development of malignant cystic lesions. Conclusion: Using CE-EUS and endoscopic fine-needle puncture as diagnostic criteria seemed to be a feasible method to deal with different cystic lesions in daily practice.

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