Endoscopic ultrasound in differentiation of solid pancreatic head lesions: A single centre experience.

[BACKGROUND] Precise characterization of pancreatic head lesions remain a challenge even with all the radiological advancement. Pancreatic adenocarcinoma is the most common malignant lesion, but many other malignant and benign pathology can masquerade with similar clinical and radiological features.

[AIM] To see the role of endoscopic ultrasound (EUS) in characterizing solid pancreatic head lesions.

[METHODS] This is a retrospective analysis of prospectively maintained databases in a tertiary care centre of north India. Patients with suspicious solid mass lesion in pancreatic head in computed tomography or magnetic resonance imaging who underwent EUS-guided fine needle biopsy in last 3 (2020-2022) years were analyzed. Those who have at least 6 months of follow up or follow up until surgery or death were included. Different EUS characteristics were compared to look for predictors of malignant head lesions.

[RESULTS] Total 92 patients enrolled, among which 53 patients excluded and 39 included in final analysis. Twenty-four (61.5%) patients had pancreatic adenocarcinoma, 1 (2.6%) neuro-endocrine cancer, 11 (28.2%) inflammatory head mass, 2 (5.1%) auto immune pancreatitis and 1 had pancreatic tuberculosis. History of acute pancreatitis in recent past significantly favoured benign pathology. Increased pancreatic duct diameter (5.2 ± 2.5 mm 3.3 ± 1 mm; = 0.01) and negative duct penetrating sign [22 (88%) 7 (50%); = 0.03] predicted malignancy. In EUS-elastography both qualitative (colour pattern) ( = 0.01) and quantitative (strain ratio) ( = 0.02) parameters found to be significant predictor of malignant lesion.

[CONCLUSION] This study showed some promising preliminary results of EUS and EUS elastography in differentiation of solid pancreatic head lesion. But it requires validation in larger and prospective study.