Interventional EUS for pancreatic disease

Introduction: EUS-FNA is widely accepted procedure for the diagnosis and therapy of pancreatic disease. The Aim: The aim is to assess the availability of EUS-FNA in pancreatic disease. Objectives: Pancreatic lesions were 290 of 428 which were performed EUS-FNA from July 2000 to December 2009. Methods: 1) The accuracy of histopathological results of 222 pancreatic masses was evaluated. 2) DOP-PCR CGH analysis was done for 16 pancreatic cancer patients using tissues obtained by EUS-FNA. 3) 11 patients were evaluated the sensitivity for GEM with HSP27 immunostaining. 4) EUS-guided pancreatic cyst drainage (EUS-CD) was performed for 27 lesions (20 men and 7 women, mean age 56.8 years). Mean size was 79mm (38–200mm). We punctured with 19G needles. About lately 14 pseudocysts, stents and nasocystic catheter were placed simultaneously. 5) EUS-guided choledochoduodenostomy (EUS-CDS) was performed for 5 pancreatic cancer patients (2 men and 3 women, mean age 69.6 years). We punctured with 19G needles and placed a straight plastic stent. 6) 2 pancreatic cancer patients underwent dendritic cell injection therapy by procedure of EUS-FNA. 7) The antiproliferative activity of combined administration with GEM and IFNgamma was evaluated in vitro and in vivo. GEM-resistant cells were transplanted on nude mice, then IFNgamma was injected within tumor, and GEM was administered systemically. Result: 1) The sensitivity, specificity and accuracy of EUS-FNA in solid pancreatic masses were 95.0%, 94.1%, and 94.8%. 2) Genetic alterations were identified same as surgical and autopsy tissues. 3) Patients with high HSP27 expression had worse prognosis. 4) 25 of 27 lesions (92.5%) were decreased or disappeared. 5) All EUS-CDS were successful. Especially, our handmade plastic stents were useful to prevent slipping out. 6) No adverse event was occurred after DC injection therapy. 7) The sensitivity for GEM was improved in vitro. And tumor growth was tended to be inhibited in vivo. Conclusion: EUS-FNA has unlimited potential as therapeutic and diagnostic EUS for pancreatic diseases.