7%, i e , acute pancreatitis, severe bleeding, minor bleeding, se

7%, i.e., acute pancreatitis, severe bleeding, minor bleeding, self-limited abdominal pain or minor abdominal disconfort. Also 1 death is reported in one series (66). A cost-effective analysis for asymptomatic incidental solitary cystic pancreatic tumors demonstrated that risk stratification of malignant potential by EUS-FNA and cyst-fluid analysis Inhibitors,research,lifescience,medical was most effective (69). In conclusion, in defining the nature of a pancreatic cystic lesion CT, MRI and EUS morphology may not be enough, EUS-FNA may be of some help, combining cytology, CEA and

amylase levels in the aspirated fluid. Trucut biopsy is feasible but today we don’t have any data about the role of the new pro-core needle. We know that the echobrush is feasible, it can give us some better result compared to standard FNA, but complication risks must be considered. For the initial setup EUS and secretin MRCP are the best. Management Inhibitors,research,lifescience,medical decision should be individualized based on surgical candidacy, expertise and life expectancy. MRCP +/- EUS are the best for follow-up (70). Current role of EUS in detection, diagnosis and staging of neuroendocrine tumors of the duodenopancreatic area NETs of the duodeno-pancreatic area pose various problems in terms of diagnosis,

detection, staging and treatment. Correct preoperative diagnosis, detection and staging are mandatory in these cases, to select treatment Inhibitors,research,lifescience,medical options, type of surgical intervention and to optimize the curative approach itself, limiting time and complexity of surgical intervention, thus contributing to an improvement in results of surgery. In this clinical scenario the main endoscopic technique is represented by EUS. In the past, the only endoscopic Inhibitors,research,lifescience,medical procedure that had a role in the diagnosis of NETs of the pancreas was the ERCP, which today has completely lost any diagnostic role (replaced by magnetic resonance cholangiography and by EUS), but it has kept an exclusively operative space when drainage of the biliary tree or the pancreatic ductal Inhibitors,research,lifescience,medical system is necessary. The EUS characteristics

of pancreatic NETs are in most mafosfamide cases represented by a homogeneous echo-pattern, often hypoechogenic, rarely non- homogeneous, with cystic or calcified areas, whilst margins are clear in over 84% of patients, sometimes having a hypoechogenic border (71). In several studies, albeit with small numbers due to the rarity of the disease, EUS demonstrated high sensitivity and specificity in diagnosing NETs of the pancreatic-duodenal area, with correct detection between 57% and 89% (71-74). Sensitivity is between 80% and 90% for tumors discovered in the pancreas, whilst it drops to 30-50% for lesions located outside the pancreas, mainly gastrinomas of the duodenal wall. The most sensitive technique for detecting these latter lesions remains intraoperative endoscopic EPZ004777 transillumination (approximate 83%) and duodenectomy can increase sensitivity by a further 15% (75).

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