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World J Gastroenterol. Jun 28, 2014; 20(24): 7808-7818
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7808
Applications of endoscopic ultrasound in pancreatic cancer
Leticia Perondi Luz, Mohammad Ali Al-Haddad, Michael Sai Lai Sey, John M DeWitt
Leticia Perondi Luz, Mohammad Ali Al-Haddad, Michael Sai Lai Sey, John M DeWitt, Division of Gastroenterology and Hepatology, Indiana University, Medical Center, Roudebush VA Medical Center, Indianapolis, IN 46202, United States
Author contributions: All authors contributed equally to the intellectual conception of the manuscript and approved the final version; Luz LP and DeWitt JM performed extensive literature research and drafted the article; AL-Haddad MA and Sey MSL revised the manuscript critically.
Correspondence to: John M DeWitt, MD, Division of Gastroenterology and Hepatology, Indiana University, Medical Center, Roudebush VA Medical Center, 550 N University Blvd., UH 4100, Indianapolis, IN 46202, United States. jodewitt@iupui.edu
Telephone: +1-317-9441113   Fax: +1-317-9488144
Received: November 2, 2013
Revised: January 15, 2014
Accepted: February 16, 2014
Published online: June 28, 2014
Processing time: 241 Days and 10.4 Hours
Abstract

Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging.

Keywords: Pancreatic ductal carcinoma; Pancreatic neoplasm; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Endoscopic ultrasound guided fine-needle aspiration

Core tip: Applications of endoscopic ultrasound (EUS) in pancreatic cancer are emerging. We review the role of EUS in the detection, diagnosis and staging of pancreatic cancer. The introduction of recent novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers in fine-needle aspiration samples might improve the accuracy of EUS. In addition, we review therapeutic application of EUS including celiac plexus interventions, fiducial and brachytherapy seeds placement, fine needle injection and EUS-guided biliary drainage.