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 vs 3.3 ± 1 mm; P = 0.01) and negative duct penetrating sign [22 (88%) vs 7 (50%); P = 0.03] predicted malignancy. In EUS-elastography both qualitative (colour pattern) (P = 0.01) and quantitative (strain ratio) (P = 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.