Pancreatic masses represent a major diagnostic challenge, requiring high-precision imaging to guide therapeutic decision-making. Biliopancreatic endoscopic ultrasound (EUS) has emerged as a reference technique owing to its high resolution and the ability to perform fine-needle aspiration/biopsy (FNA/FNB). It enables detailed lesion characterization and improves the distinction between benign and malignant processes. The aim of this study was to assess the diagnostic performance of biliopancreatic EUS in the evaluation of pancreatic masses.

A retrospective descriptive and analytical study was conducted in the Hepato-Gastroenterology Department “Médecine B” of Ibn Sina University Hospital over a 3-year period (January 2022 – January 2025). All patients managed for a pancreatic mass and who underwent biliopancreatic EUS in the interventional endoscopy unit were included. Demographic, clinical, EUS, and histopathological data were collected and analyzed.

Fifty-six patients were included (31 men, 55.4 %, sex ratio 1.24), with a mean age of 64.3 ± 14.1 years. Thirty-one patients (55.3 %) were symptomatic, most commonly with cholestatic jaundice (42.9 %). EUS identified a cystic mass in 2 cases (3.6 %), a multilocular cystic lesion in 3 cases (5.4 %), and a mixed cystic–solid lesion in 2 cases (3.6 %), while 49 patients (87.5 %) had a solid mass, heterogeneous in 69.6 % and hypoechoic in 17.9 %. Most lesions were located in the pancreatic head (67.9 %), with a mean size of 40 × 30 mm. The EUS appearance suggested a pancreatic tissue process in 46 cases (82.1 %). Specific lesions were also identified, including 4 neuroendocrine tumors (7.1 %), 3 intraductal papillary mucinous tumors (IPMN, 5.4 %), along with isolated cases of pancreatic metastasis, pseudocyst, and cystic lymphangioma (Table 1). EUS-guided tissue sampling was performed in 50 patients (89.3 %) using various needle calibers, predominantly 20G ProCore (45.6 %). Histopathological analysis was positive in 15 cases (26.8 %), including 14 pancreatic ductal adenocarcinomas (21.4 % moderately differentiated, 3.6 % well-differentiated) and one well-differentiated grade 3 neuroendocrine tumor (1.8 %).

Biliopancreatic EUS is a reference technique for the evaluation of pancreatic masses, offering high-precision morphological characterization and targeted tissue acquisition. Caution remains necessary, as the pancreas is one of the organs most prone to cytopathological interpretation difficulties, sometimes requiring repeated sampling with multiple needle passes. Optimizing sampling techniques and integrating advanced EUS technologies may further enhance diagnostic performance and improve patient management.