Skip to main content
SpringerLink
Log in

Role of Endoscopic Ultrasonography in the Management of Malignant Pancreatico-biliary Disease

  • Chapter
  • First Online:
Biliopancreatic Endoscopy

  • 794 Accesses

Abstract

Biliary and pancreatic diseases are common, but accurate image diagnosis is often challenging due to the complexities of structures and locations. Transabdominal ultrasonography, multiple detector computed tomography (MDCT), or magnetic resonance imaging (MRI) may help to detect the location and spreading of the lesions but cannot provide the detailed information (such as lymph node involvement, nature of lesions), histological diagnosis, or local therapy. Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive but useful method for the diagnosis and management of biliary and pancreatic diseases, but it only can detect the ductal lesions, and its’ diagnostic and therapeutic roles are limited in some patients with complete ductal obstruction and surgical altered anatomy. Endoscopic ultrasound (EUS) is a sensitive method for detecting pancreatico-biliary lesions. The echoendoscope can approach to the pancreatico-biliary region and provide high-spatial resolution ultrasound (US) images around this area. After the introduction, EUS has been established as a useful diagnostic tool for the tumor identification, tumor staging, tumor characterization, and tissue acquisition of malignant pancreatico-biliary diseases [1]. With the continuing improvement of EUS and the development of accessories, EUS plays a more important role as an interventional modality for tumor ablation and management of tumor-associated complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Luz LP, Al-Haddad M, DeWitt J. EUS and pancreatic tumors. In: Hawes RH, Fockens P, Varadarajulu S, editors. Endosonography. Third ed. Amsterdam: Elsevier Health Sciences; 2014. p. 187–208.

    Google Scholar 

  2. Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. J Clin Ultrasound. 2009;37:1–17.

    Article  PubMed  Google Scholar 

  3. Sakamoto H, Kitano M, Kamata K, et al. Diagnosis of pancreatic tumors by endoscopic ultrasonography. World J Radiol. 2010;2:122–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Agarwal B, Abu-Hamda E, Molke KL, et al. Endoscopic ultrasound guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004;99:844–50.

    Article  PubMed  Google Scholar 

  5. Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc. 2013;78:73–80.

    Article  PubMed  Google Scholar 

  6. Chen CH, Yang CC, Yeh YH, et al. Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography. J Formosa Med Assoc. 2015;114(9):820–8.

    Article  Google Scholar 

  7. Tierney WM, Francis IR, Eckhauser F, et al. The accuracy of EUS and helical CT in the assessment of vascular invasion by peripapillary malignancy. Gastrointest Endosc. 2001;53:182–8.

    Article  CAS  PubMed  Google Scholar 

  8. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol. 2004;99:492–501.

    Article  PubMed  Google Scholar 

  9. Puli SR, Singh S, Hagedorn CH, et al. Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc. 2007;65:788–97.

    Article  PubMed  Google Scholar 

  10. Sugiyama M, Hagi H, Atomi Y, et al. Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography. Abdom Imaging. 1997;22:434–8.

    Article  CAS  PubMed  Google Scholar 

  11. Tamburrino D, Riviere D, Yaghoobi M, et al. Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev. 2016; (9). Art. No.: CD011515.

    Google Scholar 

  12. Mertz HR, Sechopoulos P, Delbeke D, et al. EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc. 2000;52:367–71.

    Article  CAS  PubMed  Google Scholar 

  13. Catalano MF, Sivak MV Jr, Rice T, et al. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc. 1994;40:442–6.

    Article  CAS  PubMed  Google Scholar 

  14. Bhutani MS, Hawes RH, Hoffman BJ. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion. Gastrointest Endosc. 1997;45:474–9.

    Article  CAS  PubMed  Google Scholar 

  15. Rosch T, Braig C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography. Gastroenterology. 1992;102:188–99.

    Article  CAS  PubMed  Google Scholar 

  16. Muller MF, Meyenberger C, Bertschinger P, et al. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994;190:745–51.

    Article  CAS  PubMed  Google Scholar 

  17. Dewitt J, Devereaux BM, Lehman GA, et al. Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol. 2006;4:717–25.

    Article  PubMed  Google Scholar 

  18. Bhutani MS, Gress FG, Giovannini M, et al. The no Endosonographic detection of tumor (NEST) study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy. 2004;36:385–9.

    Article  CAS  PubMed  Google Scholar 

  19. Fritscher-Ravens A, Brand L, Knofel WT, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002;97:2768–75.

    Article  PubMed  Google Scholar 

  20. Kitano M, Sakamoto H, Kudo M. Endoscopic ultrasound: contrast enhancement. Gastrointest Endosc Clin N Am. 2012;22:349–58.

    Article  PubMed  Google Scholar 

  21. Dietrich CF, Sharma M, Hocke M. Contrast-enhanced endoscopic ultrasound. Endosc Ultrasound. 2012;1:130–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gong TT, Hu DM, Zhu Q. Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: a meta-analysis. Gastrointest Endosc. 2012;76:301–9.

    Article  PubMed  Google Scholar 

  23. Kitano M, Kudo M, Yamao K, Takagi T, Sakamoto H, Komaki T, et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol. 2012;107:303–10.

    Article  PubMed  Google Scholar 

  24. Hou X, Jin Z, Xu C, Zhang M, et al. Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study. PLoS One. 2015;10:e0121236.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dietrich CF, Săftoiu A, Jenssen C. Real time elastography endoscopic ultrasound (RTE-EUS), a comprehensive review. Eur J Radiol. 2014;83:405–14.

    Article  CAS  PubMed  Google Scholar 

  26. Jaffri M, Sachdev AH, Khanna L, et al. The role of real time endoscopic ultrasound guided elastography for targeting EUS-FNA of suspicious pancreatic masses: a review of the literature and a single center experience. JOP. 2016;17:516–24.

    Google Scholar 

  27. Bamber J, Cosgrove D, Dietrich CF, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med. 2013;34:169–84.

    Article  CAS  PubMed  Google Scholar 

  28. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139:1172–80.

    Article  PubMed  Google Scholar 

  29. Saftoiu A, Vilmann P, Gorunescu F, et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011;43:596–603.

    Article  CAS  PubMed  Google Scholar 

  30. Pei Q, Zou X, Zhang X, et al. Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: a meta-analysis. Pancreatology. 2012;12:402–8.

    Article  PubMed  Google Scholar 

  31. Xu W, Shi J, Li X, et al. Endoscopic ultrasound elastography for differentiation of benign and malignant pancreatic masses: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2013;25:218–24.

    Article  PubMed  Google Scholar 

  32. Hu DM, Gong TT, Zhu Q. Endoscopic ultrasound elastography for differential diagnosis of pancreatic masses: a meta-analysis. Dig Dis Sci. 2013;58:1125–31.

    Article  PubMed  Google Scholar 

  33. Ying L, Lin X, Xie ZL, et al. Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: a meta-analysis. J Gastroenterol Hepatol. 2013;28:1434–43.

    Article  PubMed  Google Scholar 

  34. Kongkam P, Lakananurak N, Navicharern P, et al. Combination of EUS-FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: a prospective single-blinded study. J Gastroenterol Hepatol. 2015;30:1683–9.

    Article  PubMed  Google Scholar 

  35. Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall in Med-Eur J Ultrasound. 2013;34:238–53.

    Article  CAS  Google Scholar 

  36. Yamabe A, Irisawa A, Bhutani MS, et al. Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors. Endosc Ultrasound. 2016;5:225–32.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jani BS, Rzouq F, Saligram S, et al. Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: a systematic review of technical and procedural variables. N Am J Med Sci. 2016;8:1–11.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kandel P, Tranesh G, Nassar A, et al. EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study. Gastrointest Endosc. 2016;84:1034–9.

    Article  PubMed  Google Scholar 

  39. Nakai Y, Isayama H, Chang KJ, et al. A pilot study of EUS-guided through-the-needle forceps biopsy (with video). Gastrointest Endosc. 2016;84:158–62.

    Article  PubMed  Google Scholar 

  40. Ishiwatari H, Hayashi T, Kawakami H, et al. Randomized trial comparing a side-port needle and standard needle for EUS-guided histology of pancreatic lesions. Gastrointest Endosc. 2016;84:670–8.

    Article  PubMed  Google Scholar 

  41. Alper E, Onur İ, Arabul M, et al. Endoscopic ultrasound-guided tissue sampling: how can we improve the results? Turk J Gastroenterol. 2016;27:1–3.

    Article  PubMed  Google Scholar 

  42. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–6.

    Article  PubMed  Google Scholar 

  43. Ahmad NA, Kochman ML, Lewis JD, et al. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am J Gastroenterol. 2001;96:3295–300.

    Article  CAS  PubMed  Google Scholar 

  44. Kurihara N, Kawamoto H, Kobayashi Y, et al. Vascular patterns in nodules of intraductal papillary mucinous neoplasms depicted under contrast-enhanced ultrasonography are helpful for evaluating malignant potential. Eur J Radiol. 2012;81:66–70.

    Article  PubMed  Google Scholar 

  45. Hong SK, Loren DE, Rogart JN, et al. Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts. Gastrointest Endosc. 2012;75:775–82.

    Article  PubMed  Google Scholar 

  46. Early DS, Acosta RD, Chandrasekhara V, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc. 2013;77:839–43.

    Article  PubMed  Google Scholar 

  47. Ngamruengphong S, Xu C, Woodward TA, et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy. 2013;45:619–26.

    Article  CAS  PubMed  Google Scholar 

  48. Hirooka Y, Goto H, Itoh A, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003;18:1323–4.

    Article  PubMed  Google Scholar 

  49. Winter JM, Cameron JL, Olino K, et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis. J Gastrointest Surg. 2010;14:379–87.

    Article  PubMed  Google Scholar 

  50. Patel R, Davitte J, Varadarajulu S, et al. Endoscopic resection of ampullary adenomas: complications and outcomes. Dig Dis Sci. 2011;56:3235–40.

    Article  PubMed  Google Scholar 

  51. Roberts KJ, McCulloch N, Sutcliffe R, et al. Endoscopic ultrasound assessment of lesions of the ampulla of Vater is of particular value in low-grade dysplasia. HPB (Oxford). 2013;15:18–23.

    Article  Google Scholar 

  52. Chen CH, Yang CC, Yeh YH, et al. Reappraisal of endosonography of ampullary tumors: correlation with transabdominal sonography, CT, and MRI. J Clin Ultrasound. 2009;37:18–25.

    Article  PubMed  Google Scholar 

  53. Ceppa EP, Burbridge RA, Rialon KL, et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg. 2013;257:315–22.

    Article  PubMed  Google Scholar 

  54. Gress FG, Barawi M, Kim D, Grendell JH. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest Endosc. 2002;55:594–7.

    Article  PubMed  Google Scholar 

  55. Ashida R, Yamao K, Okubo K, et al. Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy. 2006;38:190–2.

    Article  CAS  PubMed  Google Scholar 

  56. Farrell JJ, Sherrod A, Parekh D. EUS-guided fine-needle tattooing for preoperative localization of early pancreatic adenocarcinoma. Gastrointest Endosc. 2009;69:176–7.

    Article  PubMed  Google Scholar 

  57. Lennon AM, Newman N, Makary MA, et al. EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc. 2010;72:1089–94.

    Article  PubMed  Google Scholar 

  58. Choi JH, Seo DW, Park, et al. Fiducial placement for stereotactic body radiation therapy under only endoscopic ultrasonography guidance in pancreatic and hepatic malignancy: practical feasibility and safety. Gut Liver. 2014;8:88–93.

    Article  PubMed  Google Scholar 

  59. Sanders MK, Moser AJ, Khalid A, et al. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc. 2010;71:1178–84.

    Article  PubMed  Google Scholar 

  60. Varadarajulu S, Trevino JM, Shen S, et al. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy. 2010;42:423–5.

    Article  CAS  PubMed  Google Scholar 

  61. Draganov PV, Chavalitdhamrong D, Wagh MS. Evaluation of a new endoscopic ultrasound-guided multi-fiducial delivery system: a prospective non-survival study in a live porcine model. Dig Endosc. 2013;25:615–21.

    Article  PubMed  Google Scholar 

  62. Chavalitdhamrong D, DiMaio CJ, Siersema PD, et al. Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer. Endosc Int Open. 2015;3:E373–7.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Law JK, Singh VK, Khashab MA, et al. Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery. Surg Endosc. 2013;27:3921–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Jürgensen C, Schuppan D, Neser F, et al. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63:1059–62.

    Article  PubMed  Google Scholar 

  65. Park DH, Choi JH, Oh D, et al. Endoscopic ultrasonography-guided ethanol ablation for small pancreatic neuroendocrine tumors: results of a pilot study. Clin Endosc. 2015;48:158–64.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Oh HC, Seo DW, Song TJ, et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology. 2011;140:172–9.

    Article  CAS  PubMed  Google Scholar 

  67. Chang KJ, Nguyen PT, Thompson JA, et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88:1325–35.

    Article  CAS  PubMed  Google Scholar 

  68. Hecht JR, Bedford R, Abbruzzese JL, et al. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res. 2003;9:555–61.

    CAS  PubMed  Google Scholar 

  69. Hecht JR, Farrell JJ, Senzer N, et al. EUS or percutaneously guided intratumoral TNFerade biologic with 5-fluorouracil and radiotherapy for first-line treatment of locally advanced pancreatic cancer: a phase I/II study. Gastrointest Endosc. 2012;75:332–8.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Levy MJ, Alberts SR, Bamlet WR, et al. EUS-guided fine-needle injection of gemcitabine for locally advanced and metastatic pancreatic cancer. Gastrointest Endosc. 2017;86(1):161–9.

    Article  PubMed  Google Scholar 

  71. Irisawa A, Takagi T, Kanazawa M, et al. Endoscopic ultrasound-guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas. 2007;35:189–90.

    Article  PubMed  Google Scholar 

  72. Han J, Chang KJ. Endoscopic ultrasound-guided direct intervention for solid pancreatic tumors. Clin Endosc. 2017;50:126–37.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Pai M, Habib N, Senturk H, et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg. 2015;7:52–9.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Lakhtakia S, Ramchandani M, Galasso D, et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc. 2016;83:234–9.

    Article  PubMed  Google Scholar 

  75. Arcidiacono PG, Carrara S, Reni M, et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc. 2012;76:1142–51.

    Article  PubMed  Google Scholar 

  76. Song TJ, Seo DW, Lakhtakia S, et al. Initial experience of EUS-guided ablation of unresectable pancreatic cancer. Gastrointest Endosc. 2016;83:440–3.

    Article  PubMed  Google Scholar 

  77. Chan HH, Nishioka NS, Mino M, et al. EUS-guided photodynamic therapy of the pancreas: a pilot study. Gastrointest Endosc. 2004;59:95–9.

    Article  PubMed  Google Scholar 

  78. Choi JH, Oh D, Lee JH, et al. Initial human experience of endoscopic ultrasound-guided photodynamic therapy with a novel photosensitizer and a flexible laser-light catheter. Endoscopy. 2015;47:1035–8.

    Article  PubMed  Google Scholar 

  79. Doi S, Yasuda I, Kawakami H, et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs, celiac plexus neurolysis: a randomized multicenter trial. Endoscopy. 2013;45:362–9.

    Article  CAS  PubMed  Google Scholar 

  80. Wang K-X, Jin Z-D, Du Y-Q, et al. EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study. Gastrointest Endosc. 2012;76:945–52.

    Article  PubMed  Google Scholar 

  81. Itoi T, Kasuya K, Sofuni A, et al. Endoscopic ultrasonography-guided pancreatic duct access: techniques and literature review of pancreatography, transmural drainage and rendezvous techniques. Dig Endosc. 2013;25:241–52.

    Article  PubMed  Google Scholar 

  82. Isayama H, Nakai Y, Kawakubo K, et al. The endoscopic ultrasonography-guided rendezvous technique for biliary cannulation: a technical review. J Hepatobiliary Pancreat Sci. 2013;20:413–20.

    Article  PubMed  Google Scholar 

  83. Itoi T, Dhir V, Moon JH. EUS-guided biliary drainage: moving into a new era of biliary drainage. Gastrointest Endosc. 2017;85:915–7.

    Article  PubMed  Google Scholar 

  84. Dhir V, Isayama H, Itoi T, et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Digest Endosc. 2017;29:472–85.

    Article  Google Scholar 

  85. Bank JS, Adler DG. Lumen apposing metal stents: a review of current uses and outcomes. Gastrointest Interv. 2017;6:9–14.

    Article  Google Scholar 

  86. Khashab MA, Bukhari M, Baron TH, et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open. 2017;5:E275–81.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Itoi T, Baron TH, Khashab MA, et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Digest Endosc. 2017;29:495–502.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Yuan’s General Hospital, Kaohsiung, Taiwan

    Meng-Shun Sun M.D.

Authors
  1. Meng-Shun Sun M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meng-Shun Sun M.D. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Kwok-Hung Lai

  2. Show-Chwan Health Care System, Chang-Hua, Taiwan

    Lein-Ray Mo

  3. Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Hsiu-Po Wang

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sun, MS. (2018). Role of Endoscopic Ultrasonography in the Management of Malignant Pancreatico-biliary Disease. In: Lai, KH., Mo, LR., Wang, HP. (eds) Biliopancreatic Endoscopy. Springer, Singapore. https://doi.org/10.1007/978-981-10-4367-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4367-3_14

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4366-6

  • Online ISBN: 978-981-10-4367-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation