Diagnostic value of EUS-guided SF6 pancreatography for pancreatic cystic lesions on cyst communication with the pancreatic duct

Background and Objectives: ERCP remains the reliable method to determine whether pancreatic cystic lesions (PCLs) and pancreatic duct communicate when other modalities (computed tomography, magnetic resonance imaging, and EUS) fail. However, complications after ERCP are still a risk that should not be ignored. In this study, we evaluated the value of EUS-guided SF6 pancreatography (ESP) for the diagnosis of PCLs focusing on pancreatic cyst communication with the pancreatic duct. Patients and Methods: We reviewed the database of medical records to retrieve the clinicopathological data of the patients with PCLs who had undergone ESP, and analyzed the diagnostic value of ESP to determine communication between the cyst and the pancreatic duct. The inclusion criteria were as follows: (1) PCLs were pathologically diagnosed by postsurgery specimen or through-the-needle biopsy and (2) ESP was performed to determine communication between the pancreatic cyst and the pancreatic duct. Results: Pathological diagnosis confirmed communication with the pancreatic duct in all eight patients with positive pancreatography, among whom seven were branch-duct-intraductal papillary mucinous neoplasm (BD-IPMN) and one was the main duct-IPMN. Pathological diagnosis confirmed noncommunication with the pancreatic duct in 20 of the 21 patients with negative pancreatography, among whom 11 were mucinous cystic neoplasm, 7 were serous cystic neoplasm, 1 was solid pseudopapillary neoplasm, 1 was pancreatic pseudocyst, and 1 was BD-IPMN. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ESP to determine communication between the pancreatic cyst and the pancreatic duct were 96.6% (28/29), 88.9% (8/9), 100% (20/20), 100% (8/8), and 95.2% (20/21), respectively. Conclusions: ESP achieved high accuracy to determine communication between the pancreatic cyst and the pancreatic duct.