EUS-guided intra-tumoral therapies

Area of Science:

• Gastroenterology and Oncology
• Minimally Invasive Therapeutic Techniques

Background:

• Endoscopic ultrasound (EUS)-guided treatments for focal tumor lesions have evolved over 20 years, initially using alcohol injection.
• Pancreatic tumors are frequently targeted due to accessibility, with EUS offering a potential alternative to surgery.
• Advances in imaging detect more pancreatic lesions, including pancreatic cystic neoplasms (PCNs) and neuroendocrine tumors (NETs), raising management questions for asymptomatic incidentalomas.

Purpose of the Study:

• To review the development and application of EUS-guided treatments for pancreatic lesions.
• To discuss the management challenges of incidental nonfunctional NETs smaller than 2 cm.
• To highlight the potential of EUS-guided therapies to challenge surgical interventions for pancreatic tumors.

Main Methods:

• Review of literature on EUS-guided treatments for focal pancreatic lesions.
• Discussion of diagnostic modalities including EUS-guided fine-needle aspiration (EUS-FNA).
• Analysis of therapeutic options for pancreatic cystic neoplasms and neuroendocrine tumors.

Main Results:

• EUS-guided treatments, including alcohol injection, have been established for two decades.
• EUS management is considered a safe alternative for pancreatic tumors, especially incidentalomas.
• EUS-guided treatments are being developed for pancreatic adenocarcinoma, with ongoing studies.

Conclusions:

• EUS-guided treatments represent a significant advancement in managing pancreatic focal lesions.
• The accessibility and safety profile of EUS offer a viable alternative to surgery for selected pancreatic tumors.
• EUS-guided therapies are increasingly challenging traditional surgical decision-making for pancreatic incidentalomas and adenocarcinomas.