Published online Apr 16, 2022. doi: 10.4253/wjge.v14.i4.191
Peer-review started: May 7, 2021
First decision: July 27, 2021
Revised: August 9, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: April 16, 2022
Processing time: 336 Days and 6.3 Hours
There has been a growing interest in developing endoscopic ultrasound (EUS)-guided interventions for pancreatic cancer, some of which have become standard of care. There are two main factors that drive these advancements to facilitate treatment of patients with pancreatic cancer, ranging from direct locoregional therapy to palliation of symptoms related to inoperable pancreatic cancer. Firstly, an upper EUS has the capability to access the entire pancreas–lesions in the pancreatic head and uncinate process can be accessed from the duodenum, and lesions in the pancreatic body and tail can be accessed from the stomach. Secondly, there has been a robust development of devices that allow through-the-needle interventions, such as placement of fiducial markers, brachytherapy, intratumoral injection, gastroenterostomy creation, and ablation. While these techniques are rapidly emerging, data from a multicenter randomized controlled trial for some procedures are awaited prior to their adoption in clinical settings.
Core Tip: Interventional endoscopic ultrasound in pancreatic cancer has been developed via a through-the-needle fashion, using 2 techniques: Injection and/or placement. Examples of through-the-needle injection techniques include intratumoral therapy, injection of alcohol and bupivacaine for celiac plexus neurolysis, and hydrogel for bleb formation to create space in the pancreaticoduodenal groove for dose-escalation stereotactic body radiation therapy. Examples of through-the-needle placement techniques include placement of fiducial markers, placement of ablative probes for non-thermal and thermal therapies, placement of radioactive seeds for brachytherapy, and placement of a lumen-apposing metal stent to create a gastrojejunostomy in patients with gastric outlet obstruction. The vast majority of these techniques have shown comparable or superior outcomes when compared to conventional interventions and therapies.