Pancreas cysts are sac-like collections of fluid in the pancreas. Most cysts are not cancerous, although some may have the potential to turn into cancer. More and more pancreatic cysts are being detected today due to the increased use of radiographic imaging. Many patients getting a CT scan or MRI for one reason may be incidentally found have a pancreas cyst.
This is a very difficult question for gastroenterologists to answer. Sometimes there are imaging features seen on imaging or endoscopic ultrasound (EUS) that may point towards signs of cancer. For cysts that have concerning features based on accepted guidelines the gold standard for diagnosis is to sample the fluid from the cyst using EUS to analyze for possible tumor cells or premalignant features (i.e. mucin).
How to manage these incidental cysts can be challenging because it is difficult to predict which of these cysts may turn into a cancer. To improve our diagnostic accuracy using EUS, we have the capability of inserting a small laser fiber (confocal endomicroscopy) probe through our EUS needle into the pancreatic cyst to obtain real-time microscopic imaging of the cyst wall. Studies have shown this technique may improve accuracy of diagnosis of certain types of pancreatic cysts.
The gold standard for treating pancreas cysts with concerning features for cancer is surgical removal – which is not a small intervention. Many patients do not want to undergo a massive operation for a lesion that may or may not be certain for cancer.
For patients who want to avoid surgery, or are not good surgical candidates, we have the capability of treating these cysts from inside the body using endoscopic ultrasound. Through an EUS needle a specially designed probe can be inserted into a pancreas cyst, which has the capability of delivering radiofrequency energy. This energy can destroy the cyst lining from the inside of the body rather than undergoing a large surgery. This is a brand new technology that may change how we manage pancreas cysts. We can offer this to select patients as part of a Therapeutic EUS Registry established at Methodist Dallas Medical Center.
Are you interested in learning more about EUS-guided endomicroscopy or RFA? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.