title: What are the current and potential future roles for endoscopic ultrasound in the treatment of pancreatic cancer?
abstract: Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound (EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUS-guided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.
authors.affiliation: Stephen Y Oh, Shayan Irani, Richard A Kozarek, the Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA 98101, United States.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Stephen Y Oh, Shayan Irani, Richard A Kozarek, the Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA 98101, United States.
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.affiliation: Stephen Y Oh, Shayan Irani, Richard A Kozarek, the Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA 98101, United States.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
keywords: Endoscopic ultrasound; Endoscopic ultrasound-guided ablation; Endoscopic ultrasound-guided anti-tumor therapy; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided celiac plexus neurolysis and block; Endoscopic ultrasound-guided fiducial placement; Endoscopic ultrasound-guided gastrojejunal anastomosis; Palliation; Pancreatic cancer