OBJECTIVES: The traditional radiological staging of pancreatic carcinoma by pancreatography allied to cross-sectional imaging may not always be accurate or confirm the diagnosis. The aim of this study was to assess the role of endoscopic ultrasound (EUS) in the preoperative staging of suspicious or confirmed pancreatic carcinoma. METHODS: All patients undergoing staging pancreatic EUS between January 1996 and December 2004 were identified from the radiology computerised database. Fifty-eight patients (36 male, mean age of 61 ± 1.6 years) were identified all of whom had undergone prior US and CT and 35 prior ERCP, and 28 of whom underwent EUS guided biopsy. Thirty-seven patients had a mass believed to be a carcinoma and 21 had a suspicious lesion in the pancreatic head. RESULTS: Thirty-two of the 37 patients with a mass on prior imaging had a diagnosis of carcinoma confirmed (mean diameter 3.1 +/- 0.3 cm). Fifteen tumours were deemed irresectable on EUS criteria: portal vein (n=4) or superior mesenteric vein invasion (n=8); unrecognised liver metastases (n=4), ascites (n=1); lymph nodes metastases outside the resection limits (n=1). Only 1 patients underwent an open and close laparotomy due to a discrepancy between operative and EUS findings (small right liver lobar metastasis). The EUS diagnosis of the remaining 5 masses were: pancreatitis (n=2); peripancreatic lymph node (n=1); pancreatic cystic tumour (n=1) and IPMT (n=1). Eleven of the 21 patients with suspicious pancreatic lesions were confirmed as carcinomas (3 irresectable), 3 patients had chronic pancreatitis, 1 patient IPMT, 1 patient gallbladder carcinoma, and in 5 patients no mass was evident on EUS. CONCLUSIONS: EUS was effective in assessing resectability of pancreatic adenocarcinomas in cases in which there was CT suspicion of mesenteric or portal vessel invasion and also facilitated targeted biopsies in order to confirm a diagnosis of carcinoma.