Invasive Tests

Endoscopic Ultrasound (EUS)

How it works: EUS is one of the most useful imaging studies for diagnosing pancreatic cancer. An outpatient procedure, it provides detailed images of the pancreas and surrounding tissues including the liver, blood vessels, and lymph nodes. EUS relies on high frequency soundwaves to create a picture of the organs. When the soundwaves bounce off of the internal organs, they send echoes to a computer which creates a visual image. 

EUS involves passing a thin lighted tube, called an endoscope, through your mouth then into your stomach and duodenum. The ultrasound probe is attached to the tip of the endoscope. Since the endoscope allows the ultrasound probe to get very close to the pancreas and its surrounding organs, detailed pictures can be produced, and small tumors in the pancreas can be detected. 

The real-time needle guidance provided by the EUS procedure enables the physician to biopsy a suspicious cyst or suspected tumor in a process called Fine Needle Aspiration (FNA). To learn more about biopsy procedures, click here.

What to Expect: During the test you will be under heavy conscious sedation. Throughout the procedure you will retain a minimum level of consciousness allowing you to breathe on your own and respond to verbal and physical prompts. The sedation should keep you from feeling physical discomfort during the procedure. You will be positioned on your side and once you are properly sedated, the endoscope will be passed through your mouth and into your stomach and duodenum. If your doctor uses FNA to biopsy a cyst or a mass, you will be given IV antibiotics and asked to take oral antibiotics for a few days at home after the procedure. The EUS procedure takes approximately 1 hour. 

Considerations: Due to the sedation, you will not be able to drive yourself home after the procedure and should arrange for someone to pick you up. Complications with EUS procedures are very rare but may include pancreatitis, gastrointestinal bleeding, and adverse reactions to the sedative medication. Infection of a pancreatic cyst after FNA is also possible, and typically antibiotics are given to reduce that risk. 

Endoscopic Retrograde Cholangiopancreatography (ERCP)

How it works: ERCP allows the physician to visualize the bile and pancreatic ducts. The study is most often performed when a patient exhibits symptoms of jaundice, which can indicate presence of a mass narrowing or blocking the ducts.

Like EUS, ERCP is an outpatient procedure involving an endoscope - a long, thin, lighted tube passed through the mouth, through the stomach, and into the duodenum. To conduct the procedure, a tube called a catheter is threaded through the endoscope and directly into the pancreatic and bile ducts. Dye is injected through the catheter and into the ducts and then an X-ray is taken.

If a blockage, or stricture, is found, the physician can intervene by placing a stent into the obstructed duct. A stent is a device that helps hold the duct open to allow bile and pancreatic juices to flow properly.

What to expect: As with EUS, during the ERCP procedure, you will be positioned on your side and placed under heavy conscious sedation.

Considerations: Due to the sedation, you will not be able to drive yourself home after the procedure and should arrange for someone to pick you up. About 5-7% of patients experience pancreatitis after ERCP. While in most cases the pancreatitis is mild, serious pancreatitis can occur. Gastrointestinal bleeding, infection, and adverse reactions to the sedative anesthesia are other, rare complications associated with ERCP. Some patients may be allergic to the contrast dye used to visualize the ducts. If you have any known allergies to contrast dyes, iodine, or shellfish, you should alert your physician before undergoing the procedure.