Role of endoscopic ultrasound in treatment of pancreatic cancer

Abstract

Endoscopic ultrasound (EUS) can help diagnose diseases with high accuracy because it overcomes the limitations of gastrointestinal gas and abdominal fat. The emergence of curved linear-array echoendoscopy has significantly promoted the applications of the technique to new levels. The advancement has appeared from EUS imaging to EUS-guided fine needle aspiration, drainage and injection. Computed tomography and magnetic resonance imaging present certain limitations for diagnosing pancreatic tumors due to the specificity of the location of such growths. In addition, traditional chemotherapy does not show ideal results because pancreatic cancer (PC) exhibits hypovascular characteristics. Interventional EUS can overcome these limitations and has potential to become the mainstream method of PC local treatment in the future. This paper reviews the use of interventional EUS in the treatment of PC based on previous studies.

Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma

“…Median VAS score reduction was 57.1% (95% CI 41.3-72.1%) in Group 1 and 71.4% (56.2-87.9%) in Group 2 (P = 0.01). Median time to pain relief was 5 days (2-9) in Group 1 and 3 days (2-5) in Group 2 (P = 0.11), whereas median duration of pain relief was 10 (7-14) and 18 (13)(14)(15)(16)(17)(18)(19)(20) weeks in the two groups, respectively (P = 0.004). After the procedure, reduction in opioid use was observed in 18 (31%) out of 58 patients treated with EUS-CPN and 37 (56.9%) of 65 patients who underwent the combined treatment (P = 0.003) with a median reduction in opioid dosage At univariate logistic regression, initial VAS score, pre-procedural opioid use, tumor diameter, and EUS technique used for the treatment resulted as being significantly associated with pain relief onset (Table 3).…”

“…[4][5][6] In fact, CPN, which implies the permanent destruction of nerve endings by means of ethanol or phenol-based solution injection, aims to inhibit the ascending pain information from pancreas to central nervous system. 15 However, given the suboptimal results either in terms of pain control and of duration of pain relief of EUS-CPN, other technical attempts have been performed, such as EUS-celiac ganglia neurolysis (EUS-CGN, i.e., direct injection of alcohol into the celiac ganglia), 16,17 EUS-broad plexus neurolysis (i.e., neurolysis extended over the superior mesenteric artery), 7 and EUS-guided interstitial implantation of 125 I seeds into celiac ganglia. 18 However, none of these techniques have proven effective in prolong patients' survival because of the absence of direct action against the tumoral mass.…”

“…The combined treatment increased pain relief and complete pain response rate (P = 0.005 and 0.003, respectively). Median duration of pain relief was 10 (7-14) and 18 (13)(14)(15)(16)(17)(18)(19)(20) weeks in the two groups, respectively (P = 0.004). At multivariate regression, initial visual analog scale score and endoscopic technique adopted resulted significantly associated with pain relief.…”

Diagnostic accuracy of diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion for the detection of abdominal solid cancer

“…Endoscopic US is essential for the diagnosis of pancreatic cancer with fine-needle aspiration (25). In addition, US is used as a screening method for pancreatic cancer; however, it is limited by field-of-view restriction, due to the presence of gas in the stomach and intestine (26).…”

Short-term outcomes of laparoscopic local resection for gastric submucosal tumors: a single-center experience of 266 patients

“…Submucosal tumors (SMTs) of the stomach are defined as tumors located beneath the gastric mucosa and include gastrointestinal stromal tumors (GISTs), schwannomas, leiomyomas, malignant lymphomas, lymphangiomas, lipomas, hemangiomas, heterotopic pancreas, et al [1]. We can always perceive gastric SMTs accidently, which make up 2% of whole gastric neoplasms [2].…”