Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective

Abstract

Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a delay in diagnosis and treatment, resulting in poor clinical outcomes and low survival rates. Endoscopic Ultrasound (EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era, with exponential advancements in technology and device innovation, EUS is also being increasingly used in a variety of therapeutic interventions. In the context of pancreatic cancer where therapies are limited due to the advanced stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover, due to their minimally invasive nature and ability to provide real-time images for tumor localization and therapy, they are associated with fewer complication rates compared to conventional open and laparoscopic approaches. In this article, we detail the most current and important therapeutic applications of EUS for pancreatic cancer, namely EUS-guided Fine Needle Injections, EUS-guided Radiotherapy, and EUS-guided Ablations. Furthermore, we also discuss the feasibility and safety profile of each intervention in patients with pancreatic cancer to provide gastrointestinal medical oncologists, radiation and surgical oncologists, and therapeutic endoscopists with valuable information to facilitate patient discussions and aid in the complex decision-making process.

Role of Endoscopic Ultrasound in Pancreatic Cancer Diagnosis and Management

“…In the small study of eight patients, two had a partial response in tumor size, while one had a minimal response; however, the follow-up study comparing this technique to gemcitabine was terminated early due to inferior efficacy in the EUS–FNI cohort [ 62 ]. Other therapeutic agents utilizing EUS–FNI for unresectable pancreatic adenocarcinoma have been explored, including dendritic cell-based immunotherapy, oncolytic viruses, and direct chemotherapy injection [ 63 , 64 ]. However, studies remain largely limited to animal studies and human case series with limited efficacy and safety data.…”