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Review
. 2023 Sep 15:13:1252824.
doi: 10.3389/fonc.2023.1252824. eCollection 2023.

Utility of interventional endoscopic ultrasound in pancreatic cancer

Wei On  1 , Wafaa Ahmed  1 , Simon Everett  1 , Matthew Huggett  1 , Bharat Paranandi  1
Affiliations
Review

Utility of interventional endoscopic ultrasound in pancreatic cancer

Wei On et al. Front Oncol. .

Abstract

Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.

Keywords: endoscopic ultrasound; interventional endoscopy; pancreatic cancer; pancreatic ductal adenocarcinoma; pancreatobiliary endoscopy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YK declared a shared affiliation with the authors to the handling editor at the time of review.

Figures

Figure 1
Figure 1
(A) Fluoroscopic image demonstrating successful creation of a choledochoduodenostomy with a lumen apposing metal stent. (B) Axial computed tomography image of the same patient showing the position of an appropriately placed choledochoduodenostomy stent.
Figure 2
Figure 2
(A) Fluoroscopic image of contrast opacifying the left sided intrahepatic ducts with placement of a hepaticogastrostomy stent. (B) Gastric end of the stent protruding from the cardia into the gastric lumen.
Figure 3
Figure 3
(A) Radiological evidence of gastric outlet obstruction. (B) Fluoroscopic capture of the stenosis being bypassed with a wire passed down an endoscope with contrast infused into the jejunum to identify a suitable limb for gastrojejunostomy formation. (C) Endosonographic views of a distended jejunal bowel loop and successful placement of a lumen apposing metal stent. (D) Endoscopic view following successful EUS guided gastrojejunostomy with reflux of methylene blue stained contrast solution into the stomach.
Figure 4
Figure 4
(A) Endosonographic identification of the aorta and the coeliac trunk take-off from the stomach. (B) Red arrow depicts injection needle targeting the space above the coeliac trunk for central injection.
See this image and copyright information in PMC

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