State of the art lecture: Endoscopic ultrasound (EUS) and FNA in pancreatico-biliary tumors

Introduction In the past few decades, there has been relatively little change in the epidemiology, therapy, or over-all survival of pancreatico-biliary tumors. However, we are now in an era where diagnostic and therapeutic paradigms are finally going beyond traditional approaches (cytology/pathology for diagnosis and cytotoxic agents for therapy) with the potential of changing the natural history of these tumors. Many of these new approaches are made possible with emerging diagnostic and interventional EUS techniques. This state-of-the-art paper will review the role of EUS-guided FNA in the diagnosis of pancreaticobiliary lesions such as pancreatic tumors, cystic and neuroendocrine tumors of the pancreas, as well as the less appreciated applications to biliary and ampullary cancers. I will also discuss the specific role of EUS-guided FNA in the staging of various pancreaticobiliary cancers. The role of EUS-guided therapies, including celiac neurolysis, cyst-gastrostomy, and delivery of anti-tumor agents via EUS-guided fine needle aspiration (FNI) will be covered in the accompanying article ”FNI and Anti-tumor therapy”.