Evaluation and Staging of Pancreaticobiliary Malignancy

Abstract Endoscopic ultrasound (EUS) permits the most detailed nonoperative view of the pancreas and extrahepatic biliary system that is available. This facilitates the detection of malignant pancreaticobiliary lesions at an early stage before such lesions become detectable by conventional cross-sectional imaging like computed tomography (CT) or magnetic resonance (MR). The tissue acquisition (TA) capabilities of EUS add a substantial depth to its clinical applications, providing a safe and accurate method to confirm various types of pancreaticobiliary pathologies prior to initiation of therapy. EUS continues to play an important role in the care of pancreaticobiliary malignancies by triaging patients to operative or non-operative care largely due to its ability to detect early metastasis and vascular invasion. Recently, EUS provided a solid platform for a variety of novel tissue and imaging-based technologies that can help render better-quality care to this group of patients. This chapter summarizes the role of EUS for the evaluation of solid malignant pancreatic and biliary neoplasms.