Endoscopy 2018; 50(04): S60
DOI: 10.1055/s-0038-1637205
ESGE Days 2018 oral presentations
20.04.2018 – EUS: diagnostic
Georg Thieme Verlag KG Stuttgart · New York

DIFFERENTIATION OF PANCREATIC CYSTS BY CONTRAST-ENHANCED ENDOSCOPIC ULTRASONOGRAPHY

M Patricia Olar
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Gastroenterology, Cluj Napoca, Romania
2   Regional Institute of Gastroenterology and Hepatology, Gastroenterology, Cluj Napoca, Romania
,
O Mosteanu
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Gastroenterology, Cluj Napoca, Romania
2   Regional Institute of Gastroenterology and Hepatology, Gastroenterology, Cluj Napoca, Romania
,
I Rusu
3   Regional Institute of Gastroenterology and Hepatology, Pathology, Cluj Napoca, Romania
,
A Seicean
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Gastroenterology, Cluj Napoca, Romania
2   Regional Institute of Gastroenterology and Hepatology, Gastroenterology, Cluj Napoca, Romania
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

It is a great challenge to differentiate between the type and the malignant potential of a newly diagnosed pancreatic cyst. Our aim was to assess the role of contrast-enhanced endoscopic ultrasonography (EUS) for increasing diagnostic accuracy.

Methods:

The prospective study included 40 patients with pancreatic cysts. Inclusion criteria were: age over 18, presence of a pancreatic cyst larger than 10 mm, informed consent. Exclusion criteria were: history of chronic pancreatitis, platelet count < 50.000/cm3, refuse of the patient to participate. We analyzed the cyst wall, the septa and the solid components of the pancreatic cyst with and without contrast enhancer (CE) (2,4 ml SonoVue-Bracco, Italy). The examinations were performed using an Olympus echoendoscope and Aloka ultrasound machine. The final diagnosis was based on fine needle aspiration result, surgery or follow-up.

Results:

There were 40 patients (27 females, 13 males) included. Cyst size was between 12 mm-80 mm. The pancreatic location of the lesions were the head (n = 8), the uncinate process (n = 9), the neck (n = 6), the body (n = 13), and the tail (n = 4). The types of cysts were serous cystadenoma (n = 6); mucinous cystadenoma (n = 6); mucinous cystadenocarcinoma (n = 1); Intraductal Papillary Mucinous Neoplasm (IPMN) (n = 22); pseudocyst (n = 5). For the serous cystadenomas, a hyperenhancement of the cyst wall and septa with a slow wash-out and honeycomb aspect was observed. In case of mucinous cystadenomas hyperenhanced thick walls, septa and fast wash-out was characteristic. For IPMN's, the hyperenhancement of the cyst wall and fast wash-out was found. All the pseudocyst presented hypoenhancement or no enhancement of cyst wall. From 10 pancreatic cysts with solid components in standard EUS, hyperenhanced mural nodules were present in 8 of them and malignancy was confirmed for all this cases (surgery n = 5; EUS-FNA n = 3)

Conclusions:

The enhancing pattern was useful to differentiate malignant nodules from mucus or debris and mucinous from nonmucinous pancreatic cystic lesions.