الفهرس 
Introduction &Aim of the workOnly 14 pages are availabe for public view
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Abstract
We conclude that EUS-FNA is a more sensitive and accurate modality of cytopathological diagnosis than ERCP cytology for solid pancreatic neoplasms, particularly in tumors located at the pancreas body and tail, and in tumors more than 2 cm in size. Although diagnosis of pancreatic lesions less than 10 mm in size and lesions located at pancreas head and uncus is thought to be technically challenging, our data showed that EUS-FNA was accurate in the evaluation of solid pancreatic neoplasms regardless of size and location.
We recommend the use of EUS-FNA as the first procedure for definite diagnosis of solid pancreatic mass lesions following cross-sectional imaging. It is also recommended for cases in which cytology on previous ERCP was negative and for those in which histological evidence of malignancy is needed before chemotherapy. However, patients with thrombocytopenia, uncontrolled coagulopathy, patients with intraductal papillary mucinous neoplasm with an associated invasive cancer (IPMN-IC) and those who suspected to have carcinoma in situ (CIS), ERCP cytology is preferred.
Fortunately sensitivity, specificity and accuracy of combined procedures (group C) were high and moreover adverse events rate were similar among the three procedures, EUS-FNA, ERCP and combined. We were not fundamentally intend to recommend combined procedures for diagnosis of solid pancreatic mass, because sensitivity, specificity, and accuracy is enough high in group A, combined procedures are not the standard, they can be performed only by endoscopists experienced in both EUS and ERCP and there is a risk of post-ERCP pancreatitis. Combined EUS-FNA and ERCP may maximize diagnostic accuracy especially in difficult cases of EUS-FNA, and highly suspicious lesions with previous repeated negative EUS-FNA. Another indication of combined procedures is to detect carcinoma in situ (CIS) or faint infiltrations without the presence of a formed mass. Since there are various methods of sampling tissue, it is important to choose the procedure while considering the patient’s condition and safety. Recommendation of combined EUS-FNA and ERCP will require analyzing larger number of cases in a prospective study.