Abstract
Endoscopic ultrasonography (EUS) is highly accurate in the diagnosis of chronic pancreatitis.
Both parenchymal and ductal changes indicative of chronic pancreatitis can be identified.
Parenchymal changes include small cystic abnormalities and hyperechoic foci scattered
throughout the gland; the entire gland may be enlarged in early chronic pancreatitis,
or small and atrophic in advanced disease. Ductal changes include enlargement of the
main pancreatic duct or secondary branches, and the presence of stones or proteinaceous
plugs within the ducts. Pseudocysts appear as cystic structures of mixed echogenicity;
EUS is able to detect small pseudocysts or masses not identified by conventional imaging
modalities. EUS has some difficulty in distinguishing benign from malignant pancreatic
masses, particularly when the lesions are small. EUS should not supplant the use of
CT scan or ERCP in the differential diagnosis of pancreatic disease, but is rather
an adjunct to these studies. Future clinical research should focus on determining
the appropriate indications for EUS in pancreatic disease, and determining if patient
outcomes are favorably affected by the diagnostic information obtained.
