Interventional Therapy for Pancreatic Cancer.

Area of Science:

• Gastroenterology
• Oncology
• Interventional Endoscopy

Background:

• Pancreatic cancer (PC) management often relies on palliative chemotherapy and chemoradiotherapy for advanced stages.
• Conventional endoscopy and endoscopic ultrasound (EUS) are increasingly vital for PC management.
• PC remains a significant cause of cancer mortality, with limited survival improvements despite treatment advances.

Approach:

• This review discusses advancements in conventional endoscopy and EUS for PC management.
• EUS-guided interventions enable targeted delivery of agents (e.g., radioactive seeds) and neurolysis for pain management.
• Conventional endoscopy facilitates stent placement for biliary and duodenal obstructions.

Key Points:

• EUS-guided fine needle injection (FNI) shows feasibility for local therapy, but long-term efficacy is unproven.
• EUS-guided celiac plexus neurolysis (CPN) offers effective pain relief, though duration is limited.
• Endoscopic stent placement is preferred for biliary/duodenal obstruction; metal stents offer longer patency than plastic stents.

Conclusions:

• Endoscopic and EUS-guided interventions are becoming mainstream for local PC treatment due to their minimally invasive nature and real-time visualization.
• Metal stents are the preferred choice for biliary obstruction management.
• Further research is needed to establish the long-term effectiveness of EUS-FNI in pancreatic cancer.