The endoscopists in the Pancreas Center are able to perform endoscopic ultrasound, with fine needle aspiration or injection (FNA/I) as needed, for a variety of diagnostic and therapeutic indications. The most common indications for EUS are for pancreatic cysts and suspected pancreatic cystic and solid tumors. For patients with pancreatic cysts, imaging with EUS is complemented by analysis of cyst fluid for cytology, tumor markers, and genetic mutational analysis. Inflammatory diseases of the pancreas, including acute and chronic pancreatitis, are evaluated by EUS. In some cases secretin stimulation of pancreatic secretions is used during the examinations to better visualize ductal anatomy and to evaluate pancreatic function.
Therapeutic indications for EUS include drainage of pancreatic and peripancreatic fluid collections, injection of the celiac plexus for pain control, and most recently for EUS/ERCP rendezvous procedures (ERVP). ERVP harnesses the power of EUS to provide access to bile and pancreatic ducts under fluoroscopy to facilitate therapeutic ERCP procedures. In these procedures the ducts of interest are first accessed via a direct transduodenal or transgastic route when standard ERCP access techniques fail due to difficult or surgically altered anatomy.
High quality ERCP is available to many patients through their own gastroenterologists. If you feel your patient would benefit from our consultation, and outside films of these procedures are available, patients and referring physicians are encouraged to forward the films with the patient for review. Additionally, the Pancreas Center offers a full range of advanced diagnostic and therapeutic ERCP procedures that may not be available locally.