EUS AND ERCP IN THE EARLY DIAGNOSIS OF PANCREATIC CANCER

Abstract

Improving the prognosis of pancreatic cancer requires diagnosis and treatment at the earliest possible stage, ideally at stage 0 or Ⅰ. Recently, progress has been made in accumulating cases and advancing diagnostic knowledge for early-stage pancreatic cancer. EUS provides a high detection rate even when CT or MRI cannot visualize a tumor, and is useful for evaluating hypoechoic areas around the pancreatic duct and for surveillance in high-risk individuals. When EUS-guided fine-needle aspiration is inconclusive or technically challenging, such as in stage 0 or small invasive cancers, pancreatic juice cytology via ERCP can aid in diagnosis. In particular, serial pancreatic juice aspiration cytological examination (SPACE) using endoscopic nasopancreatic drainage catheters offers a high diagnostic sensitivity. Combining SPACE with other cytologic methods, such as single-sample or brush cytology, further improves diagnostic accuracy. A multimodal diagnostic approach utilizing both EUS and ERCP is essential for accurate diagnosis and treatment planning in patients with early-stage pancreatic cancer.