Endoscopic ultrasound guided interventions in the management of pancreatic cancer

Abstract

There has been a growing interest in developing endoscopic ultrasound (EUS)-guided interventions for pancreatic cancer, some of which have become standard of care. There are two main factors that drive these advancements to facilitate treatment of patients with pancreatic cancer, ranging from direct locoregional therapy to palliation of symptoms related to inoperable pancreatic cancer. Firstly, an upper EUS has the capability to access the entire pancreas–lesions in the pancreatic head and uncinate process can be accessed from the duodenum, and lesions in the pancreatic body and tail can be accessed from the stomach. Secondly, there has been a robust development of devices that allow through-the-needle interventions, such as placement of fiducial markers, brachytherapy, intratumoral injection, gastroenterostomy creation, and ablation. While these techniques are rapidly emerging, data from a multicenter randomized controlled trial for some procedures are awaited prior to their adoption in clinical settings.

Chinese expert consensus on multidisciplinary diagnosis and treatment of pancreatic neuroendocrine liver metastases

“…[42] It operates closer to the organs adjacent to the digestive tract, is less invasive, and can simultaneously perform biopsies of the metastatic liver lesion and the primary pancreatic lesion, making it especially useful when biopsies of both primary and metastatic lesions are required. [43]…”

“…[42] It operates closer to the organs adjacent to the digestive tract, is less invasive, and can simultaneously perform biopsies of the metastatic liver lesion and the primary pancreatic lesion, making it especially useful when biopsies of both primary and metastatic lesions are required. [43] Expert consensus Endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B) is efficacious for both metastatic liver lesions and primary pancreatic lesions and is less invasive. EUS-FNA/B is the preferred technique for simultaneously obtaining biopsies of pNENs primary lesions and liver metastases.…”