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World J Gastroenterol. Aug 7, 2022; 28(29): 3814-3824
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3814
Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence
Marco Spadaccini, Glenn Koleth, James Emmanuel, Kareem Khalaf, Antonio Facciorusso, Fabio Grizzi, Cesare Hassan, Matteo Colombo, Benedetto Mangiavillano, Alessandro Fugazza, Andrea Anderloni, Silvia Carrara, Alessandro Repici
Marco Spadaccini, Glenn Koleth, Kareem Khalaf, Cesare Hassan, Matteo Colombo, Alessandro Fugazza, Andrea Anderloni, Silvia Carrara, Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Milan 20800, Italy
James Emmanuel, Department of Gastroenterology and Hepatology, Queen Elizabeth, Kota Kinabalu 88200, Sabah, Malaysia
Antonio Facciorusso, Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia 71122, Italy
Fabio Grizzi, Department of Immunology and Inflammation, Humanitas Clinical and Research Hospital, Rozzano 20089, Italy
Benedetto Mangiavillano, Digestive Endoscopy Unit, Division of Gasteroenterology, Humanitas Mater Domini, Castellanza 21053, Italy
Author contributions: Spadaccini M provided the outline; Koleth G with Spadaccini M performed most of the writing and equally contributed to this paper; Emmanuel J wrote on contrast-enhanced endoscopic ultrasound; Carrara S provided valuable oversight, all EUS pictures, and concluded the manuscript; Grizzi F provided the picture for fractal analysis; Khalaf K, Colombo M, Mangiavillano B, Fugazza A, Anderloni A, Facciorusso A, and Repici A provided input in writing the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Spadaccini, MD, Associate Specialist, Senior Researcher, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and University, Via Manzoni 56, Milan 20800, Italy. marco.spadaccini@humanitas.it
Received: April 9, 2022
Peer-review started: April 9, 2022
First decision: May 9, 2022
Revised: June 7, 2022
Accepted: July 5, 2022
Article in press: July 5, 2022
Published online: August 7, 2022
Abstract

Early detection of pancreatic cancer has long eluded clinicians because of its insidious nature and onset. Often metastatic or locally invasive when symptomatic, most patients are deemed inoperable. In those who are symptomatic, multi-modal imaging modalities evaluate and confirm pancreatic ductal adenocarcinoma. In asymptomatic patients, detected pancreatic lesions can be either solid or cystic. The clinical implications of identifying small asymptomatic solid pancreatic lesions (SPLs) of < 2 cm are tantamount to a better outcome. The accurate detection of SPLs undoubtedly promotes higher life expectancy when resected early, driving the development of existing imaging tools while promoting more comprehensive screening programs. An imaging tool that has matured in its reiterations and received many image-enhancing adjuncts is endoscopic ultrasound (EUS). It carries significant importance when risk stratifying cystic lesions and has substantial diagnostic value when combined with fine needle aspiration/biopsy (FNA/FNB). Adjuncts to EUS imaging include contrast-enhanced harmonic EUS and EUS-elastography, both having improved the specificity of FNA and FNB. This review intends to compile all existing enhancement modalities and explore ongoing research around the most promising of all adjuncts in the field of EUS imaging, artificial intelligence.

Keywords: Pancreatic ductal adenocarcinoma, Pancreatic cancer, Endoscopic ultrasound, Contrast-enhanced endoscopic ultrasound, Endoscopic ultrasound contrast agents, Endoscopic ultrasound elastography, Artificial intelligence, Fractal analysis, Endoscopy, Imaging

Core Tip: Several reviews have evaluated the use of contrast-enhanced endoscopic ultrasound (CE-EUS), EUS-elastography (EUS-E), and artificial intelligence in separation. Not many have reviewed all three modalities' strengths in a single article. This article elaborates on current methods and outcomes of CE-EUS and EUS-E while reviewing the impact of artificial intelligence on the field of EUS imaging.