Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

Figure 1 Endoscopic ultrasound-guided fine needle aspiration of a mass in the pancreatic head. Arrows show the needle course to the tip of the needle within the hypoechoic mass (bottommost arrow).

Figure 2 Algorithmic approach to a pancreatic mass.

Figure 3 Representative endoscopic ultrasound biopsy and fine needle aspiration needles. A: 19G core biopsy needle; B: 22G core biopsy needle; C: 25G core biopsy needle; D: 19G FNA needle; E: 22G FNA needle; F: 25G FNA needle.

Figure 4 Schematization of the “fanning” technique for endoscopic ultrasound-guided fine needle aspiration. Dashed lines represent the change in course of the aspiration needle during each needle pass.

Figure 5 Confocal laser endomicroscopy miniprobe through a 19G FNA needle. Photo provided with permissions by Mauna Kea, Paris, France.

Figure 6 Miniature biopsy forceps. A: In open position, passing through a 19G FNA needle; B: EUS view of open biopsy forceps through the FNA needle. Photo provided with permissions by US Endoscopy, Mentor, OH.