Endoscopic ultrasound in the clinical staging and management of pancreatic cancer: its impact on cost of treatment.

BACKGROUND Surgical resection for pancreatic cancer carries a 5% 5-year survival rate. Most conventional methods of imaging do not detect small pancreatic tumors and do not accurately stage pancreatic neoplasms. There is a significant impact on medical resources despite the relatively small number of patients affected. For these reasons, careful selection of patients for surgical resection is necessary. METHODS Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) have been developed to overcome limitations of conventional staging. We address the issues of how EUS may provide cost-effective treatment in the patient with pancreatic cancer. RESULTS EUS produces high-resolution images of the pancreas, which can detect small pancreatic tumors and accurately stage pancreatic neoplasms. Evaluation with EUS-guided FNA selects patients who would benefit most from surgical resection. EUS also can be used to deliver palliative treatment for pain at the initial time of staging. EUS with FNA identifies patients most likely to benefit from surgical resection and thus channels health care resources more appropriately. CONCLUSIONS Defining this patient population helps to reduce direct medical care costs in pancreatic cancer. However, prospective data are lacking in this regard and will need to be addressed in the future. When palliative care is the goal for patients, EUS-guided fine-needle injection techniques can be used for celiac neurolysis and possibly in the future use of antitumor agents.