Abstract
Pancreatic cancer is one of the common causes of cancer-associated mortality with a dismal overall prognosis which has remained virtually unchanged over decades. In the present era, the management of patients with pancreatic cancer involves a multi-disciplinary team of radiologists, gastroenterologists, surgical oncologists, medical oncologists, radiation oncologists and other specialists. The advancement of interventional endoscopy has made a significant impact in the management of pancreatic cancers. Since the inception of endoscopic ultrasound, it has evolved over the last few decades in the management of pancreatic malignancies and its role in staging and tissue acquisition is well established. There is an emerging role of endoscopic ultrasound in the treatment and palliation of unresectable pancreatic cancer. The aim of this article is to review the role of endoscopic ultrasound in diagnostic and therapeutic interventions in the current era.
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References
Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Siegel RL, Miller KD, Wagle NS et al (2023) Cancer statistics, 2023. CA Cancer J Clin 73:17–48. https://doi.org/10.3322/caac.21763
DiMagno EP, Buxton JL, Regan PT et al (1980) Ultrasonic endoscope. Lancet 1:629–631. https://doi.org/10.1016/s0140-6736(80)91122-8
Rawla P, Sunkara T, Gaduputi V (2019) Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 10:10–27. https://doi.org/10.14740/wjon1166
Tempero MA, Malafa MP, Al-Hawary M et al (2021) Pancreatic adenocarcinoma, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw: JNCCN 19:439–457. https://doi.org/10.6004/jnccn.2021.0017
Toft J, Hadden WJ, Laurence JM et al (2017) Imaging modalities in the diagnosis of pancreatic adenocarcinoma: a systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol 92:17–23. https://doi.org/10.1016/j.ejrad.2017.04.009
Rahman MIO, Chan BPH, Far PM et al (2020) Endoscopic ultrasound versus computed tomography in determining the resectability of pancreatic cancer: a diagnostic test accuracy meta-analysis. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc 26:113–119. https://doi.org/10.4103/sjg.SJG_39_20
Krishna SG, Rao BB, Ugbarugba E et al (2017) Diagnostic performance of endoscopic ultrasound for detection of pancreatic malignancy following an indeterminate multidetector CT scan: a systemic review and meta-analysis. Surg Endosc 31:4558–4567. https://doi.org/10.1007/s00464-017-5516-y
Kitano M, Yoshida T, Itonaga M et al (2019) Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol 54:19–32. https://doi.org/10.1007/s00535-018-1519-2
Nawaz H, Fan CY, Kloke J et al (2013) Performance characteristics of endoscopic ultrasound in the staging of pancreatic cancer: a meta-analysis. JOP : J Pancreas 14:484–497. https://doi.org/10.6092/1590-8577/1512
Varadarajulu S, Tamhane A, Eloubeidi MA (2005) Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 62:728–736. https://doi.org/10.1016/j.gie.2005.06.051. (quiz 751, 753)
Fritscher-Ravens A, Brand L, Knofel WT et al (2002) Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 97:2768–2775. https://doi.org/10.1111/j.1572-0241.2002.07020.x
Bhutani MS, Gress FG, Giovannini M et al (2004) The No Endosonographic Detection of Tumor (NEST) Study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy 36:385–389. https://doi.org/10.1055/s-2004-814320
Iglesias-Garcia J, Lindkvist B, Larino-Noia J et al (2012) Endoscopic ultrasound elastography. Endoscopic ultrasound 1:8–16. https://doi.org/10.7178/eus.01.003
Emori T, Ashida R, Tamura T et al (2022) Contrast-enhanced harmonic endoscopic ultrasonography for predicting the efficacy of first-line gemcitabine and nab-paclitaxel chemotherapy in pancreatic cancer. Pancreatol Off J Int Assoc Pancreatol 22:525–533. https://doi.org/10.1016/j.pan.2022.04.005
Harmsen FR, Domagk D, Dietrich CF et al (2018) Discriminating chronic pancreatitis from pancreatic cancer: contrast-enhanced EUS and multidetector computed tomography in direct comparison. Endoscopic ultrasound 7:395–403. https://doi.org/10.4103/eus.eus_24_18
Shin CM, Villa E (2023) The efficiency of contrast-enhanced endoscopic ultrasound (EUS) combined with EUS elastography for pancreatic cancer diagnosis: a systematic review and meta-analysis. Ultrasonography 42:20–30. https://doi.org/10.14366/usg.22103
Eloubeidi MA, Jhala D, Chhieng DC et al (2003) Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 99:285–292. https://doi.org/10.1002/cncr.11643
Eloubeidi MA, Chen VK, Eltoum IA et al (2003) Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 98:2663–2668. https://doi.org/10.1111/j.1572-0241.2003.08666.x
Banafea O, Mghanga FP, Zhao J et al (2016) Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies. BMC Gastroenterol 16:108. https://doi.org/10.1186/s12876-016-0519-z
Hebert-Magee S, Bae S, Varadarajulu S et al (2013) The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathol Off J Br Soc Clin Cytol 24:159–171. https://doi.org/10.1111/cyt.12071
Hewitt MJ, McPhail MJ, Possamai L et al (2012) EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 75:319–331. https://doi.org/10.1016/j.gie.2011.08.049
Puli SR, Bechtold ML, Buxbaum JL et al (2013) How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: a meta-analysis and systematic review. Pancreas 42:20–26. https://doi.org/10.1097/MPA.0b013e3182546e79
Lai R, Stanley MW, Bardales R et al (2002) Endoscopic ultrasound-guided pancreatic duct aspiration: diagnostic yield and safety. Endoscopy 34:715–720. https://doi.org/10.1055/s-2002-33443
Eloubeidi MA, Tamhane A, Varadarajulu S et al (2006) Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc 63:622–629. https://doi.org/10.1016/j.gie.2005.05.024
Chung MJ, Park SW, Kim SH et al (2021) Clinical and technical guideline for endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor: Korean Society of Gastrointestinal Endoscopy (KSGE). Clin Endosc 54:161–181. https://doi.org/10.5946/ce.2021.069
Khan MA, Grimm IS, Ali B et al (2017) A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 5:E363–E375. https://doi.org/10.1055/s-0043-101693
Kong F, Zhu J, Kong X et al (2016) Rapid on-site evaluation does not improve endoscopic ultrasound-guided fine needle aspiration adequacy in pancreatic masses: a meta-analysis and systematic review. PLoS One 11:e0163056. https://doi.org/10.1371/journal.pone.0163056
Facciorusso A, Gkolfakis P, Tziatzios G et al (2022) Comparison between EUS-guided fine-needle biopsy with or without rapid on-site evaluation for tissue sampling of solid pancreatic lesions: a systematic review and meta-analysis. Endoscopic ultrasound 11:458–465. https://doi.org/10.4103/EUS-D-22-00026
Alvarez-Sanchez MV, Napoleon B (2016) Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety. World J Gastroenterol 22:8257–8270. https://doi.org/10.3748/wjg.v22.i37.8257
Thosani N, Cen P, Rowe J et al (2022) Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for advanced pancreatic and periampullary adenocarcinoma. Sci Rep 12:16516. https://doi.org/10.1038/s41598-022-20316-2
Oh D, Seo DW, Song TJ et al (2022) Clinical outcomes of EUS-guided radiofrequency ablation for unresectable pancreatic cancer: a prospective observational study. Endoscopic ultrasound 11:68–74. https://doi.org/10.4103/EUS-D-21-00049
Patel JB, Revanur V, Forcione DG et al (2020) Endoscopic ultrasound-guided fiducial marker placement in pancreatic cancer: a systematic review and meta-analysis. World J Gastrointest Endosc 12:231–240. https://doi.org/10.4253/wjge.v12.i8.231
Lennon AM, Newman N, Makary MA et al (2010) EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc 72:1089–1094. https://doi.org/10.1016/j.gie.2010.07.023
Marques S, Bispo M, Leite S et al (2021) GRUPUGE perspective: endoscopic ultrasound-guided fine-needle tattooing and fiducial placement in pancreatic cancer. GE Port J Gastroenterol 28:106–110. https://doi.org/10.1159/000509194
Lahoud MJ, Kourie HR, Antoun J et al (2016) Road map for pain management in pancreatic cancer: a review. World J Gastrointest Oncol 8:599–606. https://doi.org/10.4251/wjgo.v8.i8.599
Koulouris AI, Alexandre L, Hart AR et al (2021) Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) technique and analgesic efficacy in patients with pancreatic cancer: a systematic review and meta-analysis. Pancreatol Off J Int Assoc Pancreatol 21:434–442. https://doi.org/10.1016/j.pan.2020.12.016
Asif AA, Walayat SK, Bechtold ML et al (2021) EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients - a meta-analysis and systematic review. J Community Hospital Internal Med Perspect 11:536–542. https://doi.org/10.1080/20009666.2021.1929049
Kaufman M, Singh G, Das S et al (2010) Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol 44:127–134. https://doi.org/10.1097/MCG.0b013e3181bb854d
Kruse EJ (2010) Palliation in pancreatic cancer. Surg Clin North Am 90:355–364. https://doi.org/10.1016/j.suc.2009.12.004
Han SY, Kim SO, So H et al (2019) EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: a systematic review and meta-analysis. Sci Rep 9:16551. https://doi.org/10.1038/s41598-019-52993-x
Gohil VB, Klapman JB (2017) Endoscopic palliation of pancreatic cancer. Curr Treat Options Gastroenterol 15:333–348. https://doi.org/10.1007/s11938-017-0145-z
McCarty TR, Garg R, Thompson CC et al (2019) Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 7:E1474–E1482. https://doi.org/10.1055/a-0996-8178
Chen YI, Itoi T, Baron TH et al (2017) EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 31:2946–2952. https://doi.org/10.1007/s00464-016-5311-1
Perez-Cuadrado-Robles E, Alric H, Aidibi A et al (2022) EUS-guided gastroenterostomy in malignant gastric outlet obstruction: a comparative study between first- and second-line approaches after enteral stent placement. Cancers 14. https://doi.org/10.3390/cancers14225516
Perez-Miranda M, Tyberg A, Poletto D et al (2017) EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 51:896–899. https://doi.org/10.1097/MCG.0000000000000887
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Musunuri, B., Shetty, S. Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer. Indian J Surg Oncol 15 (Suppl 2), 269–274 (2024). https://doi.org/10.1007/s13193-023-01859-w
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DOI: https://doi.org/10.1007/s13193-023-01859-w