Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 10, 2016; 8(7): 319-329
Published online Apr 10, 2016. doi: 10.4253/wjge.v8.i7.319
What are the current and potential future roles for endoscopic ultrasound in the treatment of pancreatic cancer?
Stephen Y Oh, Shayan Irani, Richard A Kozarek
Stephen Y Oh, Shayan Irani, Richard A Kozarek, the Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Oh SY wrote the manuscript; Irani S provided images and edited the manuscript; Kozarek RA received a solicitation to publish a review article from WJGE and edited the manuscript.
Conflict-of-interest statement: Dr. Stephen Y Oh has no conflicts of interest. Dr. Richard A Kozarek is an investigator for Boston Scientific and has been on the Speakers Bureau x 1 for Cook. All funds accrue to the clinic. Dr. Kozarek has owned Glaxo stock since 1983. Dr. Shayan Irani is a consultant for Boston Scientific (remittances to clinic); also provided Gore educational talk.
Open-Access: 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:
Correspondence to: Richard A Kozarek, MD, the Digestive Disease Institute at Virginia Mason Medical Center, 1100 9th Avenue, MS: C3-GAS, Seattle, WA 98101, United States.
Telephone: +1-206-2232319 Fax: +1-206-2236379
Received: October 20, 2015
Peer-review started: October 27, 2015
First decision: November 27, 2015
Revised: January 19, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: April 10, 2016

Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound (EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUS-guided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.

Keywords: Endoscopic ultrasound, Pancreatic cancer, Palliation, Endoscopic ultrasound-guided celiac plexus neurolysis and block, Endoscopic ultrasound-guided biliary drainage, Endoscopic ultrasound-guided gastrojejunal anastomosis, Endoscopic ultrasound-guided anti-tumor therapy, Endoscopic ultrasound-guided fiducial placement, Endoscopic ultrasound-guided ablation