The role of endoscopic ultrasound and minimal invasive surgery in the management of pancreatic cystyc laesion and submucosal tumors

The endoscopic ultrasound (EUS) become the most important diagnostic modality in surgical decision of pancreatic cystic lesion and submucosal tumors (SMT). Apllying therapeutic linear array EUS – fine needle biopsy (EUS-FNA) malignancy could be differentiate, and planning surgical or endoscopic therapy, resection border depends of EUS findings. Pancreatic head and body cysts are commonly treated with double pig-tail catheters and nasocystic drainage placed with therapeutic EUS. In some cases, the cystic lesion or abdominal fluid localised in he tail of the pancreas transabdominal surgical drainage were performed. SMT or mucosa originated tumors ((T:2+, N:0, M:0) were identificated with EUS, EUS-FNA, biopsies, and border-marking. In these cases laparoscopic resections were performed. In the lower gastrointestinal tract the rectal SMT and tumor are the most ideal fields for pre- and post- operative EUH staging, suggesting the optimal surgical method of resection. Laparoscopic limited border resection were performed in 6 cases (GIST: 3, carcinoid: 2 ectopic pancreas: 1). Classic laparoscopic partial gastric resection were performed successfully in 4 cases. Four cases with pancreatic cystic lesion treated endoscopically, followed surgically abdominal drainage, or restricted laparotomy. Collaboration between surgeons and gastroenterologist results limited trouble of patient's recovery and better outcome.