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Value of endoscopic ultrasonography in the observation of the remnant pancreas after pancreatectomy

, Keiji Hanada, Akinori Shimizu, Tomoyuki Minami, Naomiti Hirano, Fumiaki Hino, Tomoyuki Abe, Hironobu Amano, Yasuhiro Fujiwara
Published: 19 January 2021
PLOS ONE , Volume 16; doi:10.1371/journal.pone.0245447

Abstract: Background Endoscopic ultrasonography (EUS) is proven to be a more specific and sensitive method for detecting pancreatic lesions. However, usefulness of EUS after pancreatectomy has not been reported. This study aimed to evaluate the observational capability of EUS for the remnant pancreas (RP) after pancreatectomy. Patient and methods This single-center, retrospective study enrolled 395 patients who underwent pancreatectomy at Onomichi General Hospital between December 2002 and March 2016, 45 patients who underwent EUS for RP were included for analysis. We evaluated the usefulness of EUS for RP using logistic regression analysis. Results Complete observation of the RP was done in 42 patients (93%). In the initial surgical procedure, 21 patients underwent pancreaticoduodenectomy (PD), and 24 patients underwent distal pancreatectomy (DP). PD and DP were observed in 85% (18/21) and 100% (24/24) cases, respectively. A comparison of the detection capability of EUS and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) showed that EUS was significantly superior to contrast-enhanced CT or MRI (p < 0.01). Eight of the 45 patients showed recurrence lesions in the RP. The median recurrence period was 33 months. Predictive factors for recurrence in the univariate and multivariate analyses were significantly different in space occupying lesion with EUS findings (p < 0.01) and elevated CA19-9(p < 0.01). Conclusions EUS was able to observe the RP in almost all cases. In addition, the detection capability of EUS was significantly superior to those of CT or MRI. We recommend that all patients with RP should undergo EUS, and a longer follow-up must be performed.
Keywords: pancreatic cancer / magnetic resonance imaging / endoscopy / pancreas / lesions / Ultrasound Imaging / Computed axial tomography / Pancreatectomy

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