OBJECTIVE

To improve diagnostic and treatment outcomes in patients with pancreatic neoplasms, including those complicated by obstructive jaundice, through the implementation of emergency endoscopic ultrasonography (EUS) with biopsy and rapid cytological examination performed immediately prior to endoscopic retrograde intervention in an emergency care setting.

MATERIAL AND METHODS

A prospective analysis was conducted of 238 patients admitted with suspected obstructive jaundice to the N.V. Sklifosovsky Research Institute for Emergency Medicine between January 2023 and March 2024. The study included 49 patients with suspected pancreatic neoplasms, comprising 17 (34.7%) men and 32 (65.3%) women. The mean age of the patients was 64.4 years. Inclusion criteria were men and women aged 20—84 years with clinical and/or instrumental suspicion of a pancreatic mass lesion. Exclusion criteria included cholelithiasis, choledocholithiasis, viral hepatitis, and cholangiocarcinoma.

RESULTS

All 49 (100%) patients underwent EUS with fine-needle puncture (EUS-FNP). According to EUS findings, the lesion was localized in the pancreatic head in 38 (77.5%) patients, in the pancreatic body in 6 (12.2%) patients, and in the pancreatic tail in 5 (10.3%) patients. Adequate material for cytological examination was obtained using EUS-FNP in 47 (95.9%) patients. In the study group, EUS was performed at a mean of 20±8.7 hours after hospital admission. The duration of the diagnostic EUS ranged from 10 to 22 minutes, fine-needle puncture from 15 to 21 minutes, and the subsequent endoscopic retrograde intervention from 15 to 90 minutes.

CONCLUSION

The use of EUS with fine-needle aspiration biopsy and rapid cytological examination demonstrated high effectiveness in the verification of pancreatic neoplasms (95.9%). Biliary decompression was successfully performed in all patients with obstructive jaundice. According to our data, post-procedural complications observed after EUS-FNP in the setting of obstructive jaundice were heterogeneous and were most likely attributable to the subsequent endoscopic retrograde intervention. The application of EUS with morphological verification of pancreatic neoplasms reduced the duration of the diagnostic workup and facilitated earlier initiation of specialized medical care.