The Role of Contrast Enhanced Endoscopic Ultrasound in Pancreatic Diseases

Abstract

Contrast enhancement involves the administration of an intravenous agent during the (endoscopic) ultrasound study. Contrast agents are microbubbles that respond to energy from sound waves in characteristic ways which aid in enhancing the distinctions between tissue types. They are categorized into first and second generation based on the capability for transpulmonary passage and the half-life in the human body. Contrast-Enhanced endoscopic ultrasound (CE-EUS) is a newly established method which combines the advantage of high-resolution ultrasound (US) of internal organs with the administration of ultrasound contrast agents (UCAs). The indications of contrast enhanced endoscopic ultrasound in pancreatic diseases are acute pancreatitis, pancreatic cysts, neoplasms e.g. benign pancreatic tumour and pancreatic cancer. The lack of nephrotoxicity of CE-EUS contrast agents is of particular importance in patients with pancreatitis because of the fact that most severely ill patients develop renal failure. The contrast enhanced endoscopic ultrasound in acute pancreatitis appears as iso- or hypervascular and shows regular vascularization with the detection of venous vessels. The use of contrast enhanced endoscopic ultrasound in pancreatic cancer is to evaluate vascularity using contrast agents to characterize the lesion(s). CE-EUS helps in visualizing the microvasculature of a pancreatic lesion to permit the characterization of intertumoral structures. Further studies are needed to emphasize the role of contrast enhanced endoscopic ultrasound for the diagnosis of different pancreatic diseases.