The American Society of Gastrointestinal Endoscopy (ASGE) has recommended

mentoring of 25 or more cases of pancreatic FNA in order for endoscopists to achieve competence (2). Pancreatic cancer is now the fourth leading cause of cancer – related deaths in the United States, and its incidence appears to be increasing. The disease is associated with a high mortality rate and a median survival of approximately four months in untreated patients. Unfortunately most click here patients with pancreatic cancer present at an advanced stage of the disease when surgical cure is no longer possible. The regional anatomy of the pancreas is complex, making procurement of Inhibitors,research,lifescience,medical pathologic samples difficult. Traditionally, CT-guided fine needle aspiration Inhibitors,research,lifescience,medical (FNA), and endoscopic retrograde cholangiopancreatography (ERCP) has been

used for biopsy of the pancreas. Both have been associated with a false negative rate of 20% and 30% respectively (3). Endoscopic ultrasound and fine needle aspiration (EUS) was developed in the 1980s, and allows identification of pancreatic lesions as small as 2-3 mm, as well as the detection of small, occult regional metastases in patients Inhibitors,research,lifescience,medical with pancreatic tumors, and may also be used for staging. There has been a recent nationwide trend towards EUS-FNA for the initial evaluation for pancreatic lesions. Also, recent investigations into EUS guided fine needle injection/ablation therapy are being conducted for treating unresectable Inhibitors,research,lifescience,medical tumors (4-9). Accurate staging of patients with pancreatic cancer is critical to avoid the expense, morbidity, and mortality related to unnecessary surgery. The impact on cost and management of pancreatic cancers has been evaluated, and may be reduced by nearly $33,000 primarily by avoiding unnecessary surgical explorations (10). Clinical considerations Patient age, gender, social history, symptoms and clinical findings are essential. Also necessary are radiologic data: location of the lesion(s) in pancreas, Inhibitors,research,lifescience,medical is it solid, cystic, multicystic Tolmetin or mixed. Endoscopic findings should

also be available. Is there any pertinent prior history (tumor, any treatment, has a stent been placed?). Also, what is the working diagnosis? Techniques Sampling techniques include: Intraoperative FNA of the pancreas at the time of laparotomy; Pre-operative CT/US guided FNA – percutaneous approach; ERCP; EUS FNA. 21 gauge or thinner needle (23 to 25 gauge are preferable, as there is less bleeding, without sacrificing diagnostic material). Increasing needle size correlates with increasing complications. Five to six passes are recommended for pancreatic aspirates (however diagnostic yield depends on many factors including type and cellularity of the lesion, quality of the pass, experience of the aspirator etc.).