Endoscopic ultrasound in differentiation of solid pancreatic head lesions: A single centre experience

doi:10.4253/wjge.v18.i2.113393

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Feb 16, 2026 (publication date) through Feb 4, 2026

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Endosc. Feb 16, 2026; 18(2): 113393
Published online Feb 16, 2026. doi: 10.4253/wjge.v18.i2.113393

Endoscopic ultrasound in differentiation of solid pancreatic head lesions: A single centre experience

Pabitra Sahu, Subhashish Mazumdar, Jata Shankar Kumar, Ashish Garg, Sanchit Singh, PraveenKumar Rejliwal, Premashish Kar

Pabitra Sahu, Subhashish Mazumdar, Jata Shankar Kumar, Ashish Garg, Sanchit Singh, PraveenKumar Rejliwal, Premashish Kar, Department of Gastroenterology, MAX Super Speciality Hospital, Ghaziabad 201012, Uttar Pradesh, India

Author contributions: Sahu P, Mazumdar S, Kumar JS, and Kar P contributed to the study concept/design, data analysis and interpretation, and manuscript drafting; Sahu P, Mazumdar S, Kumar JS, Garg A, Singh S, and Rejliwal P contributed to data acquisition; Kar P supervised the project; and all authors read and approved the manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of MAX Super Speciality Hospital, approval No. EC/NEW/INST/2023/UP/0234.

Informed consent statement: Informed consent taken for all cases.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: Data sharing has been approved by all the authors.

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: Pabitra Sahu, MD, DM, Assistant Professor, Consultant, Postdoctoral Fellow, Department of Gastroenterology, MAX Super Speciality Hospital, Vaishali, Ghaziabad 201012, Uttar Pradesh, India. pabitra.sahu89@gmail.com

Received: August 26, 2025
Revised: October 11, 2025
Accepted: December 17, 2025
Published online: February 16, 2026
Processing time: 164 Days and 6.6 Hours

Abstract

BACKGROUND

Precise characterization of pancreatic head lesions remain a challenge even with all the radiological advancement. Pancreatic adenocarcinoma is the most common malignant lesion, but many other malignant and benign pathology can masquerade with similar clinical and radiological features.

AIM

To see the role of endoscopic ultrasound (EUS) in characterizing solid pancreatic head lesions.

METHODS

This is a retrospective analysis of prospectively maintained databases in a tertiary care centre of north India. Patients with suspicious solid mass lesion in pancreatic head in computed tomography or magnetic resonance imaging who underwent EUS-guided fine needle biopsy in last 3 (2020-2022) years were analyzed. Those who have at least 6 months of follow up or follow up until surgery or death were included. Different EUS characteristics were compared to look for predictors of malignant head lesions.

RESULTS

Total 92 patients enrolled, among which 53 patients excluded and 39 included in final analysis. Twenty-four (61.5%) patients had pancreatic adenocarcinoma, 1 (2.6%) neuro-endocrine cancer, 11 (28.2%) inflammatory head mass, 2 (5.1%) auto immune pancreatitis and 1 had pancreatic tuberculosis. History of acute pancreatitis in recent past significantly favoured benign pathology. Increased pancreatic duct diameter (5.2 ± 2.5 mm vs 3.3 ± 1 mm; P = 0.01) and negative duct penetrating sign [22 (88%) vs 7 (50%); P = 0.03] predicted malignancy. In EUS-elastography both qualitative (colour pattern) (P = 0.01) and quantitative (strain ratio) (P = 0.02) parameters found to be significant predictor of malignant lesion.

CONCLUSION

This study showed some promising preliminary results of EUS and EUS elastography in differentiation of solid pancreatic head lesion. But it requires validation in larger and prospective study.

Keywords: Inflammatory head mass; Adnocarcinoma; Strain ratio; Elastography; Pancreatic head mass; Endoscopic ultrasound

Core Tip: A precise diagnosis of a pancreatic head lesions is fundamental to effective management and a favorable final outcome. This retrospective study underscores the critical role of endoscopic ultrasound (EUS) in these cases. Apart from EUS-guided biopsy, EUS characteristics like pancreatic duct diameter, pancreatic duct course and EUS elastographic parameters like color pattern, strain ratio also provide important clue to differentiate benign and malignant pancreatic head lesions.