The Evolving Role of Endoscopic Ultrasound Fine Needle Aspiration (EUS FNA) in Pancreatobiliary Disease

Aim: Endoscopic ultrasound fine needle aspiration (EUS-FNA) may be used to localise, delineate and histologically characterise pancreatic lesions. It has the ability to aspirate more than one site during the same procedure and offers an opportunity to prevent unnecessary surgical intervention. We aim to evaluate the clinical impact of EUS FNA in patients with suspected pancreatobiliary disease.

Method: Fifteen patients with a definitive or suspected pancreatic mass on CT or ultrasound were evaluated by EUS.

Results: EUS FNA established a diagnosis in 14/15 cases, of which 53.3% (8/15) had malignant disease with a mean mass diameter of 24.3mm. Of these patients, 2 had at least one failed attempt at tissue diagnosis prior to EUS FNA. Three patients were EUS TNM staged as unresectable with one benefiting from celiac plexus blockade, three had curative surgery and two deferred surgery. The remaining patients had benign pancreatic inflammatory masses and one patient, a pancreatic tail neuroendocrine tumour. There were no immediate or delayed complications.

Conclusion: Solid pancreatic mass evaluation with EUS FNA aids the selection of patients most likely to benefit from surgical resection and redirects those who may benefit from neoadjuvant therapy or celiac plexus blockade.