Salom F, Prat F. Current role of endoscopic ultrasound in the diagnosis and management of pancreatic cancer. World J Gastrointest Endosc 2022; 14(1): 35-48 [PMID: 35116098 DOI: 10.4253/wjge.v14.i1.35]
Corresponding Author of This Article
Federico Salom, MD, Medical Assistant, Department of Gastroenterology, Hospital Mexico, Avenida 41, Transversal 74, Barrio Arboles, Uruca 1641-2050, San Jose, Costa Rica. fedesalom@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2022; 14(1): 35-48 Published online Jan 16, 2022. doi: 10.4253/wjge.v14.i1.35
Current role of endoscopic ultrasound in the diagnosis and management of pancreatic cancer
Federico Salom, Frédéric Prat
Federico Salom, Department of Gastroenterology, Hospital Mexico, Uruca 1641-2050, San Jose, Costa Rica
Frédéric Prat, Servide d'Endoscopie, Hopital Beaujon, Université Paris et INSERM U1016, Clichy 92118, Paris, France
Author contributions: Salom F was responsible for the preparation of the manuscript; Prat F was responsible for revising and final approval of the article; all authors agree with the final version of this manuscript.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: http://creativecommons.org/Licenses/bync/4.0/
Corresponding author: Federico Salom, MD, Medical Assistant, Department of Gastroenterology, Hospital Mexico, Avenida 41, Transversal 74, Barrio Arboles, Uruca 1641-2050, San Jose, Costa Rica. fedesalom@yahoo.com
Received: May 5, 2021 Peer-review started: May 5, 2021 First decision: June 17, 2021 Revised: July 3, 2021 Accepted: December 21, 2021 Article in press: December 21, 2021 Published online: January 16, 2022
Abstract
Endoscopic ultrasound (EUS) has emerged as an invaluable tool for the diagnosis, staging and treatment of pancreatic ductal adenocarcinoma (PDAC). EUS is currently the most sensitive imaging tool for the detection of solid pancreatic tumors. Conventional EUS has evolved, and new imaging techniques, such as contrast-enhanced harmonics and elastography, have been developed to improve diagnostic accuracy during the evaluation of focal pancreatic lesions. More recently, evaluation with artificial intelligence has shown promising results to overcome operator-related flaws during EUS imaging evaluation. Currently, an appropriate diagnosis is based on a proper histological assessment, and EUS-guided tissue acquisition is the standard procedure for pancreatic sampling. Newly developed cutting needles with core tissue procurement provide the possibility of molecular evaluation for personalized oncological treatment. Interventional EUS has modified the therapeutic approach, primarily for advanced pancreatic cancer. EUS-guided fiducial placement for local targeted radiotherapy treatment or EUS-guided radiofrequency ablation has been developed for local treatment, especially for patients with pancreatic cancer not suitable for surgical resection. Additionally, EUS-guided therapeutic procedures, such as celiac plexus neurolysis for pain control and EUS-guided biliary drainage for biliary obstruction, have dramatically improved in recent years toward a more effective and less invasive procedure to palliate complications related to PDAC. All the current benefits of EUS in the diagnosis and management of PDAC will be thoroughly discussed.
Core Tip: Endoscopic ultrasound (EUS) is currently an essential tool in the diagnostic work-up and treatment of pancreatic cancer. Contrast-enhanced harmonics, elastography and artificial intelligence provide additional information in the evaluation of focal pancreatic lesions to improve diagnostic accuracy during EUS evaluation. Interventional EUS has dramatically improved the palliative treatment of patients with pancreatic cancer, basically for local ablation therapies, adequate pain control with celiac plexus neurolysis and EUS-guided biliary drainage for the treatment of biliary obstruction.
