Interventional procedures

Interventional techniques in the pancreas consist mainly of biopsy, drainage and embolization procedures. Fine-needle aspiration biopsy (FNAB) may be performed under US, CT or ERCP guidance. Guided fine-needle biopsy has considerably improved the accuracy of diagnosis with respect to localized abnormalities, so that a specific diagnosis of a demonstrable lesion can be obtained in most cases. Aspiration of a cyst allows analysis of its contents, and permits the identification of, for instance, complicating infection. Abscesses and cysts may be drained through a percutaneous catheter or drain. Internal drainage of a pancreatic pseudocyst into the stomach or bowel is now feasible and may avoid the need for surgery. This is advantageous to any patient but is particularly useful in individuals in whom surgery or general anaesthesia carries an increased risk of complications.

Arterial embolization is extremely useful in the management of pancreatic aneurysms and may be life-saving in cases of acute bleeding. Aneurysms usually result from chronic pancreatitis but may also occur as a result of iatrogenic vascular drainage during biopsy or surgery. Haemobilia is usually an indication for arteriography, and when it occurs in a patient with an appropriate history the presence of a pancreatic aneurysm should be strongly suspected. If the necessary expertise is available therapeutic embolization is almost always preferable to surgery in the management of pancreatic lesions that are bleeding or liable to bleed.

David J. Allison and Carl-Gustaf Standertskjold-Nordenstam