Identifying contraindications to resection in patients with pancreatic carcinoma: CONCLUSIONS Part 2
The most streamlined approach to patients with suspected pancreatic neoplasms is to perform a pancreatic protocol helical CT. In patients who have obviously unre-sectable disease, percutaneous techniques can be used to establish a tissue diagnosis. In patients whose lesions are considered surgically resectable based on the CT, the added benefit of EUS is unknown and is being actively investigated. Unfortunately, many of the available comparative studies between EUS and cross-sectional imaging techniques are biased due to the absence of blinding among the examiners, making it difficult to assess any performance advantage of one test over another. In patients in whom equivocal findings are demonstrated on CT (uncertainty regarding resectability or absence of a mass lesion), EUS helps to determine the presence of a mass lesion and of advanced disease. Patients found to have unresectable disease on EUS should be considered for FNA at the same setting to allow tissue confirmation of the diagnosis. Choose a perfect online pharmacy to get *cheap viagra pills and treat your health issue.
Collectively, the improvements in imaging tests have essentially relegated the role of ERCP to that of a therapeutic intervention for biliary decompression should surgical therapy not be undertaken. ERCP should not be routinely performed for assisting in the diagnosis of pancreatic neoplasms due to the inherent risks associated with the procedure. ERCP may be helpful, however, when other diagnostic procedures have been unsuccessful or in centres where EUS is not readily available.