Contrast enhanced EUS for pancreatic lesions

Contrast enhanced endoscopic ultrasound is an endosonographic technique in which an intravenous contrast agent reveals the vascular pattern of a lesion. In the pancreas that pattern is what separates a solid tumour from inflammatory tissue.

The use of contrast during endoscopic ultrasound (CE-EUS) can provide essential information for the evaluation of pancreatic lesions. In this case we evaluated 2 lesions, one of which did not appear in previous imaging. #EUS #EUSFNA #CEU

What endoscopic ultrasound provides

Endoscopic ultrasound combines an endoscope and an ultrasound transducer in one instrument. The probe reaches the pancreas through the stomach or duodenum, within millimetres of the organ, with no intervening bowel gas or abdominal wall. This gives resolution no other modality offers for the pancreas, detecting lesions of a few millimetres that escape CT.

Contrast enhanced endoscopic ultrasound

In CE-EUS a microbubble contrast agent is given intravenously and remains within the vascular compartment. This makes the microcirculation of a lesion visible in real time, which plain ultrasound cannot show.

What it adds in practice

Differentiation. Adenocarcinoma is hypovascular, neuroendocrine tumours are richly vascularised, and inflammatory masses enhance like surrounding parenchyma.
Detection of missed lesions not distinguishable on plain ultrasound.
Guidance of biopsy. Necrotic areas are identified so the needle targets viable tissue.

Ultrasound contrast is not iodine based and does not burden renal function.

After the procedure

The material obtained is sent for histology, and it is that report rather than the endoscopic appearance that determines the next step. Recovery is short compared with surgery: eating and normal daily activities are generally resumed within a few days. Patients are given instructions on avoiding strenuous effort and on medications affecting coagulation, in particular anticoagulants and antiplatelet agents. Decisions about further treatment are usually taken by a multidisciplinary team, taking histology, staging and general condition into account.

Key figures: Endoscopic ultrasound reaches the pancreas within a few millimetres and detects lesions of 3 to 5 mm that escape CT. Neuroendocrine tumours are graded under WHO 2019: G1 below 3 percent Ki-67, G2 3 to 20 percent, G3 above 20 percent.

Frequently asked questions

Is ultrasound contrast the same as CT contrast?

No. It consists of microbubbles that remain within the vascular compartment and are cleared through respiration. It is not iodine based and does not affect renal function, so it can be used in patients for whom CT contrast is contraindicated.

How long does recovery take?

Considerably shorter than after surgery. Eating and normal daily activities are usually resumed gradually within a few days, depending on the extent and site of the lesion. The instructions that matter concern avoiding strenuous effort and how to handle medications that affect blood clotting.