BACKGROUND: In patients suspected of pancreatic or periampullary cancer, 
abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic 
modality. A supplementary endoscopic ultrasonography (EUS) is often performed, 
although there is only limited evidence of its additional diagnostic value. The 
aim of the study is to evaluate the additional diagnostic value of EUS over CT 
in deciding on exploratory laparotomy in patients suspected of pancreatic or 
periampullary cancer.
METHODS: We retrospectively analyzed 86 consecutive patients who routinely 
underwent CT and EUS before exploratory laparotomy with or without 
pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma 
between 2007 and 2010. Primary outcomes were visibility of a mass, resectability 
on CT/EUS and resection with curative intent.
RESULTS: A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, 
EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately 
predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 
(16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these 
patients. A malignant lesion was histological proven in 11/12 (92%) of these 
patients. Overall, resectability was accurately predicted by CT and EUS in 90% 
(77/86) and 84% (72/86), respectively.
CONCLUSIONS: In patients with a visible mass on CT, suspected for pancreatic or 
periampullary cancer, EUS has no additional diagnostic value, does not influence 
the decision to perform laparotomy and should therefore not be performed 
routinely. In patients without a visible mass on CT, EUS is useful to confirm 
the presence of a tumor.