The role of endoscopic ultrasonography in diagnosis, staging, and management of pancreatic disease states

[Endoscopic ultrasound-guided biopsy for the evaluation of pancreatic tumors]

In the classical approach to pancreatic lesions, the key used to be to exclude malignancy and evaluate tumor resectability and the patient's suitability for surgery. Pancreatic biopsy was rejected because a negative result does not exclude malignancy, the risk of seeding, which could make curative surgery impossible, the low surgical risk of morbidity and mortality, and the high diagnostic efficacy of imaging techniques. In this context, pancreatic biopsy was limited to irresectable tumors, and cases with suspicion of tuberculosis, lymphoma, neuroendocrine tumors or cystic tumors. Currently, pancreatic biopsy is becoming essential for the correct management of all types of pancreatic lesions, improving therapeutic management. Endoscopic ultrasound-guided biopsy has been proven to be safe, with a low complications rate, and with higher diagnostic efficacy than that of other procedures and is probably the technique of choice for the study of pancreatic lesions.

Malabsorption testing: a review

Malabsorption syndromes often present diagnostic dilemmas to even the most experienced clinicians. Several malabsorption screening tests are available, but d-xylose testing is our initial screening method of choice. Recent innovations such as serum assays for antibodies associated with celiac sprue are improving the work-up of patients with suspected malabsorption. In addition, physicians are applying technological advances in imaging to determine the underlying pathologies responsible for the occurrence of malabsorption and maldigestion. Breath testing remains a controversial modality in the work-up of patients with malabsorption. Tubeless tests of pancreatic function are also the subject of debate due to a lack of sensitivity for diagnosing mild to moderate chronic pancreatic insufficiency. This review identifies and provides critical analysis of new developments in the field of malabsorption testing. The authors also provide a clinical algorithm for diagnosing malabsorption.