Contrast-enhanced endoscopic ultrasonography for pancreaticobiliary pathologies

Second-generation ultrasonographic contrast has been developed and it has made possible contrast-enhanced harmonic EUS (CE-EUS) based on low mechanical index. CE-EUS enables visualization of vascular structures and hemodynamics in the lesion in real time. A meta-analysis showed that CE-EUS could detect pancreatic carcinoma with high sensitivity, specificity and accuracy. Pancreatic carcinoma is typically hypoenhancing with heterogeneous, distribution of contrast on CE-EUS. It was reported that CE-EUS was useful in the differential diagnosis of malignant gallbladder lesions including polyps and wall thickness. Malignant gallbladder wall typically showed a heterogeneous distribution pattern of contrast. Moreover, software to quantify the findings of CE-EUS is now available. Thus, CE-EUS might be an indispensable diagnostic modality for pancreaticobiliary pathologies.