EUS-FNA in Pancreaticobiliary Disease | Indications, Techniques & Diagnostic Accuracy

EUS-FNA in Pancreaticobiliary Disease | Indications, Techniques & Diagnostic Accuracy
Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) is a cornerstone technique for the diagnosis and staging of pancreatic and biliary malignancies. This video provides a step-by-step, anatomy-based approach to EUS-FNA, focusing on when to perform it, how to perform it correctly, and how to maximize diagnostic yield while avoiding complications.
Whether you are a gastroenterology resident, endoscopist, or hepatobiliary specialist, this video breaks down real-world technical nuances that are often missed in textbooks.
What You’ll Learn in This Video
Clinical Indications of EUS-FNA
Pre-operative diagnosis of pancreatic and biliary mass lesions
Evaluation of solid and cystic pancreatic lesions
Sampling of peripancreatic, periportal, and retroperitoneal lymph nodes
Tumor staging and detection of peritoneal disease via ascitic fluid analysis
EUS-FNA Techniques by Anatomical Location
🔹 Pancreatic Head & Uncinate Process
Duodenal approach
Scope wedging, loop control, and puncture stability
Tips to prevent scope slippage during needle advancement
🔹 Pancreatic Body & Tail
Trans-gastric access
Managing acute angulation
Loop formation strategies for stable needle trajectory
🔹 Biliary & Gallbladder Lesions
Needle selection (25G for CBD lesions)
Avoiding bile contamination
Safety principles to prevent biliary leak
🔹 Porta Hepatis Lymph Nodes
Torque control techniques
Assistant-supported scope stabilization
Optimal visualization and safe puncture angles
Cystic Lesions: Safety & Best Practices
When and why to use a 19G needle
Complete cyst aspiration to prevent infection
Mandatory antibiotic prophylaxis
Critical contraindication: Why cyst-enterostomy is dangerous in mucinous neoplasms
Diagnostic Accuracy & Fluid Analysis
Overall diagnostic accuracy: 77–94%
High specificity with variable sensitivity
CEA 192 ng/mL as a strong marker of mucinous cystic lesions
Practical interpretation of cyst fluid results
Why EUS-FNA Is Technically Challenging
Performing EUS-FNA is like threading a needle through a moving target while looking through a narrow tunnel. Success depends on:
Scope positioning
Wall apposition
Needle control
Understanding lesion behavior under pressure
This video simplifies these challenges into clear, reproducible techniques.
Who Should Watch This?
✔ Gastroenterology & Hepatology Residents
✔ EUS Trainees & Endoscopists
✔ Pancreaticobiliary Specialists
✔ Fellowship Exam Candidates

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