Gastroenterology clinics of North America
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Techniques of endoscopic pseudocyst management continue to evolve, but the principles of proper patient selection and careful consideration of the available therapeutic options remain unchanged. Endoscopic management is considered first-line therapy in the treatment of symptomatic pseudocysts. Clinicians should be vigilant in the evaluation of all peripancreatic fluid collections to exclude the presence of a pancreatic cystic neoplasm and avoid draining an immature collection. ⋯ Endoscopic failure, especially in cases with significant necrosis, should be managed operatively. Percutaneous drainage is a good option for immature infected pseudocysts or in patients who are not optimal candidates for other procedures. Close cooperation between endoscopists, surgeons, interventional radiologists, and other healthcare providers is paramount in successfully managing these patients.
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Gastroenterol. Clin. North Am. · Mar 2012
ReviewThe role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer.
EUS with FNA is highly sensitive and specific for diagnosing pancreatic cancer. However, in certain situations, such as in patients with chronic pancreatitis, this high sensitivity and specificity can significantly diminish. ⋯ EUS has evolved from a diagnostic procedure to a therapeutic intervention in pancreatic cancer. EUS-guided fiducial insertion and EUS-guided delivery of antitumor agents, in addition to celiac plexus neurolysis, are the main therapeutic applications of EUS in pancreatic cancer.