Endoscopic Ultrasound Management of Pancreatic Lesions: From Diagnosis to Therapy

Foreword
Contents
1: Overview of Pancreatic Masses and Cystic Lesions
	1.1	 Introduction
	1.2	 Epidemiological Aspects
	1.3	 Clinical Presentation
		1.3.1	 Pain
		1.3.2	 Jaundice
		1.3.3	 Weight Loss
		1.3.4	 Diabetes
		1.3.5	 Nausea and Vomiting
		1.3.6	 Signs of Malignant Transformation of Cystic Pancreatic Neoplasms
	1.4	 Genetic Mutations and Laboratory Markers
	1.5	 Imaging: What the Clinician Should Know?
		1.5.1	 Transabdominal Ultrasound (US)
		1.5.2	 Computed Tomography (CT)
		1.5.3	 Endoscopic Ultrasound and Tissue Acquisition
		1.5.4	 MRI with MR Cholangiopancreatography (MRCP)
	1.6	 Treatment and Follow-Up of Patients with Solid and Cystic Lesions of the Pancreas
	1.7	 Conclusions
	References
2: Overview on Inflammatory Pancreatic Fluid Collection
	2.1	 Introduction
		2.1.1	 APFCs
		2.1.2	 ANCs
		2.1.3	 Pancreatic Pseudocysts
		2.1.4	 WONs
	2.2	 Conclusions
	References
3: Contrast-Enhanced Endoscopic Ultrasound and Endoscopic Ultrasound Elastography
	3.1	 Introduction
	3.2	 Contrast-Enhanced Harmonic Endoscopic Ultrasound (CH-EUS)
		3.2.1	 CH-EUS: How to Do It?
		3.2.2	 CH-EUS Features of Solid Pancreatic Masses
			3.2.2.1	 Pancreatic Intraepithelial Neoplasia (PanIN)
			3.2.2.2	 Pancreatic Adenocarcinoma
			3.2.2.3	 Neuroendocrine Tumor (NET)
			3.2.2.4	 Solid Pseudopapillary Tumor (SPN)
			3.2.2.5	 Metastases
			3.2.2.6	 Acute Pancreatitis
			3.2.2.7	 Chronic Pancreatitis
			3.2.2.8	 Autoimmune Pancreatitis
			3.2.2.9	 Lymph Nodes
			3.2.2.10	 Lymphoma
			3.2.2.11	 Pancreatoblastoma
			3.2.2.12	 Schwannoma
			3.2.2.13	 Lipoma
			3.2.2.14	 Perivascular Epithelioid Cell Tumor (PEComa)
		3.2.3	 CH-EUS Features of Cystic Pancreatic Masses
			3.2.3.1	 Simple Pancreatic Cysts and Pseudocysts
			3.2.3.2	 Intraductal Papillary Neoplasms (IPMN)
			3.2.3.3	 Mucinous Cystic Neoplasms (Cystadenoma and Cystadenocarcinoma)
			3.2.3.4	 Serous Cystadenoma
		3.2.4	 CH-EUS-Guided Tissue Sampling
	3.3	 Endoscopic Ultrasound Elastography (EUS-E)
		3.3.1	 EUS-E: How to Do It?
		3.3.2	 EUS-E Features of Solid Pancreatic Masses
			3.3.2.1	 Pancreatic Adenocarcinoma
			3.3.2.2	 Neuroendocrine Tumor
			3.3.2.3	 Solid Pseudopapillary Tumor
			3.3.2.4	 Metastases
			3.3.2.5	 Acute Pancreatitis
			3.3.2.6	 Chronic Pancreatitis
			3.3.2.7	 Autoimmune Pancreatitis
			3.3.2.8	 Lymph Nodes
		3.3.3	 EUS-E Features of Cystic Pancreatic Masses
		3.3.4	 EUS-E-Guided Tissue Sampling
	3.4	 Conclusion
	References
4: Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Lesions
	4.1	 Introduction
	4.2	 The “Standard” Technique for EUS-TA
	4.3	 How to Improve the EUS-TA Performance in Solid Pancreatic Lesions?
		4.3.1	 The Fanning Technique
		4.3.2	 Suction or Not
		4.3.3	 FNB vs. FNA
		4.3.4	 Needle Diameter
		4.3.5	 ROSE or MOSE?
		4.3.6	 Ancillary Techniques
		4.3.7	 Reducing Adverse Events
	4.4	 Conclusion
	References
5: Evidence-Based Assessment of Diagnostic Performance of Currently Available Needles and Techniques for EUS-Guided Tissue Acquisition
	5.1	 Introduction
	5.2	 EUS-FNA
		5.2.1	 Needle Size
		5.2.2	 Suction
		5.2.3	 Stylet
		5.2.4	 ROSE
		5.2.5	 Fanning Technique
	5.3	 EUS-FNB
		5.3.1	 General Concepts
		5.3.2	 Comparative Effectiveness of Different FNB Needles
	5.4	 Pancreatic Cystic Lesions
	5.5	 Confocal Laser Endomicroscopy
	5.6	 Conclusions
	References
6: Role of EUS Sampling in Pancreatic Cystic Lesions
	6.1	 Introduction
	6.2	 Cytology of Cystic Fluid
	6.3	 Amylase
	6.4	 CEA
	6.5	 Glucose
	6.6	 Molecular Markers
	6.7	 Other Biomarkers
	6.8	 Conclusion
	References
7: Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections
	7.1	 Background
	7.2	 Indications of Drainage
	7.3	 Evaluation for Drainage
	7.4	 Equipment
		7.4.1	 Echoendoscope
		7.4.2	 Stents
		7.4.3	 Accessories
	7.5	 Technique
		7.5.1	 Drainage of Pseudocyst
		7.5.2	 Drainage of WOPN
	7.6	 Complications
	7.7	 Summary and Conclusion
	References
8: EUS-Guided Pancreatic Duct Drainage
	8.1	 Indications
		8.1.1	 Clinical Manifestations
		8.1.2	 Underlying Diagnoses
		8.1.3	 Underlying Anatomy of the Pancreatic Duct
	8.2	 Contraindications
		8.2.1	 Absolute
		8.2.2	 Relative
	8.3	 Preparation
	8.4	 Equipment and Devices
		8.4.1	 Equipment
		8.4.2	 Devices
	8.5	 Techniques
		8.5.1	 Rendezvous Pancreatic Duct Drainage
		8.5.2	 Antegrade (Transluminal) Pancreatic Duct Drainage
	8.6	 Stent Placement
	8.7	 Post-Procedure
	8.8	 Adverse Events
	8.9	 Follow-Up
	8.10	 Conclusion
	References
9: Lumen-Apposing Metal Stents: Innovation in the Management of Pancreatic Fluid Collections
	9.1	 Pancreatic Fluid Collections
		9.1.1	 History and Paradigm Change
	9.2	 Indications
		9.2.1	 Technique
		9.2.2	 Available Devices
	9.3	 Repeated Interventions and Necrosectomy
	9.4	 Adverse Events
		9.4.1	 Procedure Adverse Events
		9.4.2	 Delayed Adverse Events
		9.4.3	 Efficacy and Economic Considerations
	9.5	 The Future
	References
10: Endoscopic Pancreatic Necrosectomy
	References
11: Role of Endoscopic Ultrasound in Pancreatic Cancer Screening
	11.1	 Introduction
	11.2	 Risk Factors for Pancreatic Cancer
	11.3	 Pancreatic Screening Tools
	11.4	 Diagnostic Imaging Modalities for Pancreatic Cancer Screening
	11.5	 Screening and EUS
		11.5.1	 EUS in Patients with a Family History of Pancreatic Cancer
		11.5.2	 EUS in Pancreatic Cancer Associated with Inherited Cancer Syndrome (Mutation Carriers)
		11.5.3	 EUS in IPMN
	References
12: Endoscopic Ultrasound in Pancreatic Cancer Staging
	12.1	 EUS for Tumor Size Measurement
	12.2	 EUS Detection for Vascular Invasion
	12.3	 EUS for Lymph Node Detection
	12.4	 EUS-FNA
	12.5	 Peritoneal Tumor Dissemination or Malignant Ascites
	12.6	 Celiac Ganglia Metastasis Diagnosis
	12.7	 EUS-FNA in PC After Neoadjuvant Therapy
	12.8	 Limitations
	12.9	 Conclusion
	References
13: Endoscopic Ultrasound-Guided Fiducial Marker Placement for Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer
	13.1	 Introduction
	13.2	 Role of Fiducial Placement in SBRT for Pancreatic Lesions
	13.3	 Methods of Fiducial Placement
	13.4	 Types of Fiducials for SBRT
	13.5	 Methods of Loading the Fiducial Needle
	13.6	 Optimal Location to Place Fiducials for SBRT
	13.7	 Technical Outcomes of Fiducial Insertion in Pancreatic Lesions
	13.8	 Complications of Fiducial Insertion
	13.9	 Conclusion
	References
14: Endoscopic Ultrasound-Guided Therapies for Solid Pancreatic Tumors
	14.1	 Introduction
	14.2	 EUS-Guided Direct-Mode Ablation
		14.2.1	 EUS-Guided Radiofrequency Ablation
		14.2.2	 EUS-Guided Laser Ablation
		14.2.3	 EUS-Guided Cryotherm Ablation
		14.2.4	 EUS-Guided Ethanol Ablation
	14.3	 Local Ablation and Immunomodulation
	14.4	 EUS-Guided Indirect Mode Ablation
	14.5	 Conclusions
	References
15: Endoscopic Ultrasound-Guided Pancreatic Cysts Ablation
	15.1	 Introduction
	15.2	 Technique
	15.3	 Chemotherapy and Ethanol
	15.4	 Radiofrequency Ablation
	15.5	 Available Data
	15.6	 Conclusions
	References
16: Celiac Plexus Blockade/Neurolysis
	16.1	 Introduction
	16.2	 Relevant Anatomy
	16.3	 Technique
		16.3.1	 EUS-Guided Celiac Plexus Injection
		16.3.2	 EUS-Guided Celiac Ganglia Injection
		16.3.3	 EUS-Guided Broad Plexus Injection
	16.4	 Efficacy of EUS-Guided Celiac Neurolysis
		16.4.1	 Overall Efficacy
		16.4.2	 Plexus vs. Ganglia Injection
		16.4.3	 Plexus vs. Broad Plexus Neurolysis
		16.4.4	 Bilateral vs. Unilateral Injection
		16.4.5	 Volume of Injectate
		16.4.6	 Early Neurolysis
	16.5	 Efficacy of EUS-Guided Celiac Blockade
	16.6	 Adverse Events of Celiac Blockade/Neurolysis
	16.7	 Conclusion
	References
17: Interventional Endoscopic Ultrasound in Patients on Antithrombotic Therapy
	17.1	 Introduction
	17.2	 Risk of Bleeding in Patients on Antithrombotic Therapy: A Review of the Literature
	17.3	 Management of Antithrombotic Agents
	References
18: Sedation for Endoscopic Ultrasound
	18.1	 Introduction
	18.2	 Benzodiazepine
	18.3	 Opioid Analgesics
	18.4	 α2 Adrenergic Receptor Agonist
	18.5	 Propofol
	18.6	 Combination of Sedative Agents
	18.7	 Conclusion
	References
19: Quality Measures in Endoscopic Ultrasound
	19.1	 Introduction
	19.2	 Before Endoscopy
	19.3	 During Endoscopy
	19.4	 After Endoscopy
	References
20: Conclusive Remarks and New Perspectives
	20.1	 General Concepts
	20.2	 EUS-Guided Tissue Sampling
	20.3	 EUS-Guided Drainage of PFCs
	20.4	 Therapeutic Role of EUS in Pancreatic Cancer Patients
	20.5	 New Perspectives
	References