Endoscopic Approach to the Diagnosis and Treatment of Pancreatic Disease

William R. Brugge


Curr Opin Gastroenterol. 2013;29(5):559-565. 

In This Article

Abstract and Introduction


Purpose of review: The purpose of this review is to examine the recent developments in the use of endoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic ultrasound (EUS) in the management of patients with pancreatic-biliary disease.

Recent findings: The use of ERCP to guide selective placement of pancreatic sphincterotomes, stone extraction balloons, and stents enables clinicians to treat pancreatic sphincteric and ductal disorders. Pancreatic stones are a remediable cause of recurrent pancreatitis and small calculi can be easily removed. The gold standard for the diagnosis of pancreas divisum remains ERCP and sphincterotomy is highly effective in the treatment of relapsing pancreatitis. Intraductal papillary mucinous neoplasms are the most common pancreatic malignancy and ERCP, as well as EUS can identify and sample the solid and cystic lesions. Mural nodules can be detected and sampled effectively by EUS-fine needle aspiration (FNA). The sensitivity of EUS-FNA for pancreatic adenocarcinoma is excellent (more than 85%). Although cyst fluid carcinoembryonic antigen is a very good marker for the presence of a mucinous cystic lesion, it is not an indicator of malignancy.

Summary: In summary, ERCP and EUS are important tools for the management of benign and malignant lesions of the pancreas.


The role of endoscopy in the diagnosis and management of pancreatic disease has assumed increasing importance in the past year. Endoscopic retrograde cholangio-pancreatography (ERCP) provides important therapy for a wide range of pancreatic disorders from pancreatic and biliary stone disease to sphincteric disorders to pancreatic duct diseases. Endoscopic ultrasound (EUS) has clearly established itself as an important diagnostic modality for a wide range of neoplasia, from solid to cystic lesions. EUS-guided fine needle aspiration (FNA) is a highly accurate procedure for the detection and tissue sampling of neoplasia. Endoscopic pancreatic pseudocyst drainage has become a well accepted approach for the management of simple as well as complex pseudocysts.

In this review, we will examine the recent technical developments in ERCP and EUS as they apply to pancreatic disorders. Next, we will review the management of common acute and chronic pancreatic disorders.