Changes Connected to Early Chronic Pancreatitis and Early Pancreatic Cancer in Endoscopic Ultrasonography (EUS): Clinical Implications

Chronic pancreatitis (CP) is a progressive condition that is associated with severe complications. Diagnosis of late CP is easy due to characteristic clinical presentation and pathognomonic imaging findings, such as pancreatic calcifications. Early changes, such as lobularity and a dilated main pancreatic duct, are very subtle and challenging to detect with ultrasonography (US) or even computed tomography (CT). Data were accumulating on the usefulness of EUS in the early diagnosis of CP. The sensitivity values for detecting early CP (ECP) by US, MRI, and EUS were 67-69%, 77-78%, and 81-84%, respectively. The specificity values for detecting ECP by US, MRI, and EUS were 90-98%, 83-96%, and 90-100%, respectively. Pancreatic cancer (PDAC) is one of the leading cancers worldwide, with increasing morbidity. Due to its poor prognosis and survival, early diagnosis is crucial. For this indication, EUS also shows better outcomes compared to other imaging methods, especially in tumors < 2 cm. The sensitivity and specificity for diagnosing PDAC with MRI and EUS were 52.3-93%, 77.1-89%, 72-100%, and 90%, respectively. In addition, EUS can detect precancerous conditions that are associated with a higher risk of PDAC. EUS-assisted new techniques, like elastography and contrast enhancement, facilitate the diagnosis of pancreatic lesions and make it even more accurate. Early PDAC changes, such as main pancreatic duct dilatation or irregular margins of pancreatic solid masses, may be detected with EUS. This review describes the efficacy of different imaging techniques in the early detection of CP and PDAC. In addition, we describe the useful interventions made possible by early diagnosis of PDAC and CP.