Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer

Background and aims: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is used for the diagnosis of pancreatic cancer (PC). Here, we examined the usefulness of CH-EUS for evaluating therapeutic responses in PC. Methods: The study included 23 patients with PC who received chemotherapy. Patients underwent contrast-enhanced computed tomography (CE-CT) and CH-EUS before chemotherapy and at the time of evaluation of the therapeutic response. Patients with a >= 50% reduction in serum carbohydrate antigen 19-9 levels after chemotherapy were defined as super responders. The incidence of an avascular area in the tumor on CH-EUS after chemotherapy was compared between super responders and non-super responders. Results: Nine patients were included in the super responders group. Tumor reduction rates did not differ significantly between CE-CT and CH-EUS in the super responders. The appearance of an avascular area was detected in 7 of 9 super responders (77.8%) and in 4 of 14 non-super responders (28.6%), and the difference was significant (P = 0.036). The mean survival time of patients with an avascular area after chemotherapy was longer than that of without an avascular area. Conclusions: Detection of avascular areas by CH-EUS after chemotherapy may predict long-term survival of patients with PC. (C) 2019 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.