Endoscopic Methods in the Diagnosis and Treatment of Pancreatic Cancer


Endoscopic methods are widely used in the diagnosis and palliative treatment of pancreatic cancer. The most sensitive method in early diagnosis is endosonography (EUS) which can also provide histological diagnosis. Diagnostic ERCP became a rather rare procedure as a consequence of wide availability of Magnetic Resonance Cholangiopancreatography (MRCP) but ERCP assisted intraductal methods have gained importance (brush-cytology, intraductal ultrasound, optical coherence tomography) and finally, peroral pancreatoscopy has become technically feasible but available only in some specialized centers. Minimally invasive endoscopic methods play an important role in the palliative treatment of unresectable pancreatic cancer which represents the majority of cases. EUS-guided histological confirmation of adenocarcinoma is crucial in the election of chemotherapy. Celiac plexus blockade and endoscopic biliary and pancreatic stent placement contribute to pain reduction, drainage of obstructed bile duct and assure a better quality of life.

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Z. Berger, M. Godoy and A. Reveco, "Endoscopic Methods in the Diagnosis and Treatment of Pancreatic Cancer," Journal of Cancer Therapy, Vol. 4 No. 10A, 2013, pp. 1-6. doi: 10.4236/jct.2013.410A001.

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The authors declare no conflicts of interest.


[1] P. Michl, S. Pauls and T. M. Gress, “Evidence-Based Diagnosis and Staging of Pancreatic Cancer,” Best Practice & Research Clinical Gastroenterology, Vol. 20, No. 2, 2006, pp. 227-251. http://dx.doi.org/10.1016/j.bpg.2005.10.005
[2] G. Zamboni, P. Capelli, A. Scarpa, G. Bogina, A. Pesci, E. Brunello and G. Kloppel, “Nonneoplastic Mimickers of Pancreatic Neoplasms,” Archives of Pathology & Laboratory Medicine, Vol. 133, No. 3, 2009, pp. 439-453
[3] S. T. Chari, N. Takahashi, M. J. Levy, T. C. Smyrk, J. E. Clain, R. K. Pearson, B. T. Petersen, M. A. Topazian and S. S. Vege, “A Diagnostic Strategy to Distinguish Autoimmune Pancreatitis From Pancreatic Cancer,” Clinical Gastroenterology and Hepatology, Vol. 7, No. 10, 2009, pp. 1097-1103. http://dx.doi.org/10.1016/j.cgh.2009.04.020
[4] T. Kamisawa M. Imai, P.-Y. Chen, Y. Tu, N. Egawa. K. Tsuruta, A. Okamoto and N. Suzuki Kamata, “Strategy for Differentiating Autoimmune Pancreatitis from Pancreatic Cancer,” Pancreas, Vol. 37, No. 3, 2008, pp. e62-e67
[5] P. Sahin, J. Pozsár, K. Simon, Gy. Illyés, F. László and L. Topa, “Autoimmune Pancreatitis Associated with Immune-Mediated Inflammation of the Papilla of Vater. Report on Two Cases,” Pancreas, Vol. 29, No. 2, 2004, pp. 162-166. http://dx.doi.org/10.1097/00006676-200408000-00012
[6] T. Kamisawa, Y. Tu, N. Egawa, K. Tsuruta and A. Okamoto, “A New Diagnostic Endoscopic Tool for Autoimmune Pancreatitis,” Gastrointestinal Endoscopy, Vol. 68, No. 2, 2008, pp. 358-361. http://dx.doi.org/10.1016/j.gie.2008.02.018
[7] T. Kamisawa, N. Egawa, H. Nakajima, K. Tsuruta, A. Okamoto, Y. Hayashi and N. Funata, “Gastrointestinal Findings in Patients with Autoimmune Pancreatitis,” Endoscopy, Vol. 37, No. 11, 2005, pp. 1127-1130. http://dx.doi.org/10.1055/s-2005-870369
[8] A. H. de Tejada, J. Chennat, F. Miller, T.Stricker, J. Matthews and I. Waxman, “Endoscopic and EUS Features of Groove Pancreatitis Masquerading as a Pancreatic Neoplasm,” Gastrointestinal Endoscopy, Vol. 68, No. 4, 2008, pp. 796-798. http://dx.doi.org/10.1016/j.gie.2008.02.015
[9] R. J. Shah and S. P. Martin, “Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Pancreatic Diseases,” Current Gastroenterology Reports, Vol. 2. No. 2, 2000, pp.133-145. http://dx.doi.org/10.1007/s11894-000-0097-6
[10] P. B. Cotton, D. A. Garrow, J. Gallagher and J. Romagnuolo, “Risk Factors for Complications after ERCP: A Multivariate Analysis of 11,497 Procedures over 12 Years,” Gastrointestinal Endoscopy, Vol. 70, No. 1, 2009, pp. 80-88. http://dx.doi.org/10.1016/j.gie.2008.10.039
[11] D. Domagk, J. Wessling, P. Reimer, L. Hertel, C. Poremba, N. Senninger, A. Heinecke, W. Domschke and J. Menzel, “Endoscopic Retrograde Cholangiopancreatography, Intraductal Ultrasonography, and Magnetic Resonance Cholangiopancreatography in Bile Duct Strictures: A Prospective Comparison of Imaging Diagnostics with Histopathological Correlation,” The American Journal of Gastroenterology, Vol. 99, No. 9, 2004, pp. 1684-1689. http://dx.doi.org/10.1111/j.1572-0241.2004.30347.x
[12] N. Uchida, H. Kamada, K. Tsutsui, M. Ono, Y. Aritomo, T. Masaki, Y. Kushida, R. Haba, T. Nakatsu and S. Kuriyama, “Utility of Pancreatic Duct Brushing for Diagnosis of Pancreatic Carcinoma,” Journal of Gastroenterology, Vol. 42, No. 8, 2007, pp.657-662. http://dx.doi.org/10.1007/s00535-007-2071-7
[13] S. Iqbal and P. D. Stevens, “Cholangiopancreatoscopy for Targeted Biopsies of the Bile and Pancreatic Ducts,” Gastrointestinal Endoscopy Clinics of North America, Vol. 19, No. 4, 2009, pp. 567-577. http://dx.doi.org/10.1016/j.giec.2009.06.005
[14] K. V. Chathadi and Y. K. Chen, “New Kid on the Block: Development of a Partially Disposable System for Cholangioscopy,” Gastrointestinal Endoscopy Clinics of North America, Vol. 19, No. 4, 2009, pp. 545-555. http://dx.doi.org/10.1016/j.giec.2009.06.001
[15] G. Elek, T. Gyokeres, E. Schafer, M. Burai, F. Pintér and á. Pap, “Early Diagnosis of Pancreatobiliary Duct Malignancies by Brush Cytology and Biopsy,” Pathology Oncology Research, Vol. 11, No. 3, 2005, pp. 145-155. http://dx.doi.org/10.1007/BF02893391
[16] J. Vandervoort, R. M. Soetikno, H. Montes, D. R. Lichtenstein, J. Van Dam, F. W. Ruymann, E. S. Cibas and D. L. Carr-Locke, “Accuracy and Complication Rate of Brush Cytology from Bile Duct versus Pancreatic Duct,” Gastrointestinal Endoscopy, Vol. 49.No. 3 1999, pp. 322-327.
[17] L. E. Moreno Luna, B. Kipp, K. C. Halling, T. J. Sebo, W. K. Kremers, L. R. Roberts, E. G. Barr Fritcher, M. J. Levy and G. J.Gores, “Advanced Cytologic Techniques for the Detection of Malignant Pancreatobiliary Strictures,” Gastroenterology, Vol. 131, No. 4, 2006, pp. 1064-1072.
[18] S. Pappas, M. P. Federle, A. E. Lokshin and H. J. Zeh, “Early Detection and Staging of Adenocarcinoma of the Pancreas,” Gastrointestinal Endoscopy Clinics of North America, Vol. 36, No. 2, 2007, pp. 413-429. http://dx.doi.org/10.1016/j.gtc.2007.03.013
[19] R. H. Hruban, A. Maitra, S. E. Kern and M. Goggins, “Precursors to Pancreatic Cancer,” Gastroenterology Clinics of North America, Vol. 36. No. 4, 2007, pp. 831-849.
[20] C. F. Dietrich, A. Ignee, B. Braden, A. P. Barreiros, M. Ott and M. Hocke, “Improved Differentiation of Pancreatic Tumors Using Contrast-Enhanced Endoscopic Ultrasound,” Clinical Gastroenterology and Hepatology, Vol. 6, No. 5, 2008, pp. 590-597.
[21] A. Das, C. C. Nguyen, F. Li and B. Li, “Digital Image Analysis of EUS Images Accurately Differentiates Pancreatic Cancer from Chronic Pancreatitis and Normal Tissue,” Gastrointestinal Endoscopy, Vol. 67, No. 6, 2008, pp. 861-867. http://dx.doi.org/10.1016/j.gie.2007.08.036
[22] N. B. Krishna, M. Mehra, A. V. Reddy and B. Agarwal, “EUS/EUS-FNA for Suspected Pancreatic Cancer: Influence of Chronic Pancreatitis and Clinical Presentation with or without Obstructive Jaundice on Performance Characteristics,” Gastrointestinal Endoscopy, Vol. 70, No. 1, 2009, pp. 70-79. http://dx.doi.org/10.1016/j.gie.2008.10.030
[23] S. C. Paquin, G. Gariépy, L. Lepanto, R. Bourdages, G. Raymond and A. V. Sahai, “A First Report of Tumor Seeding Because of EUS-guided FNA of a Pancreatic Adenocarcinoma,” Gastrointestinal Endoscopy, Vol. 61, No. 4, 2005, pp. 610-611.
[24] S. Dahl and M. B. Mortensen, “Endoscopic Ultrasound-Guided Fine-Needle Aspiration Can Lead to Nonresectability of Pancreatic Cancer Due to Severe Biopsy-Induced Inflammation,” Endoscopy, Vol. 40, Suppl. 2, 2008, p. E96.
[25] J. J. Farrell, A. Sherrod and D. Parekh, “EUS-Guided Fine-Needle Tattooing for Preoperative Localization of Early Pancreatic Adenocarcinoma,” Gastrointestinal Endoscopy, Vol. 69, No. 1, 2009, pp. 176-177. http://dx.doi.org/10.1016/j.gie.2008.03.1069
[26] M. H. Larsen, C. W. Fristrup and M. B. Mortensen, “Endoscopic Ultrasound-Guided Fine-Needle Marking of a Small Pancreatic Tumor,” Endoscopy, Vol. 41, Suppl. 2, 2009, pp. E175-176. http://dx.doi.org/10.1055/s-0029-1214699
[27] R. Kundu and D. Pleskow, “Clinical Application of Intraductal Ultrasound during Endoscopic Retrograde Cholangiopancreatography,” Gastrointestinal Endoscopy Clinics of North America, Vol. 19, No. 4, 2009, pp. 615-628. http://dx.doi.org/10.1016/j.giec.2009.06.004
[28] P. A. Testoni, A. Mariani, B. Mangiavillano, P. G. Arcidiacono and S. E. Di Pietro, “Intraductal Optical Coherence Tomography for Investigating Main Pancreatic Duct Strictures,” The American Journal of Gastroenterology, Vol. 102, No. 2, 2007, pp. 269-274.
[29] K. C. Chiang, C. N. Yeh, W. C. Lee, Y. Y. Jan and T. L. Hwang, “Prognostic Analysis of Patients with Pancreatic Head Adenocarcinoma Less Than 2 cm Undergoing Resection,” World Journal of Gastroenterology, Vol. 15, No. 34 ,2009, pp. 4305-4310. http://dx.doi.org/10.3748/wjg.15.4305
[30] Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-I: “Guidelines for the Management of Patients with Pancreatic Cancer Periampullary and Ampullary Carcinomas,” Gut, Vol. 54, Suppl. 5, 2005, pp. 1-16. http://dx.doi.org/10.1136/gut.2004.057059
[31] J. J. Mezhir, M. F. Brennan, R. E. Baser, M. I. D’ Angelica, Y. Fong, R. P. Dematteo, W. R. Jarnagin and P. J. Allen, “A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified,” Journal of Gastrointestinal Surgery, Vol. 13, No. 12, 2009, pp. 2163-2169. http://dx.doi.org/10.1007/s11605-009-1046-9
[32] A. Weber, T. Mittermeyer, S. Wagenpfeil, R. M. Schmid and C. Prinz, “Self-Expanding Metal Stents versus Polyethylene Stents for Palliative Treatment in Patients with Advanced Pancreatic Cancer,” Pancreas, Vol. 38, No. 1, 2009 pp. e7-e12. http://dx.doi.org/10.1097/MPA.0b013e3181870ab8
[33] T. C. Tham, D. R. Lichtenstein, J. Vandervoort, R. C. Wong, A. Slivka, P. A. Banks, H. B. Yim and D. L. Carr-Locke, “Pancreatic Duct Stents for Obstructive Type Pain in Pancreatic Malignancy,” The American Journal of Gastroenterology, Vol. 95, No. 4, 2000, pp. 956-960.
[34] Y. Liu, Z. Lu, D. W. Zou, Z. D. Jin, F. Liu, S. D. Li, X. B. Zhan, W. J. Zhang, R. P. Wu, Y. Z. Yao, L. Yang and Z. Li, “Intraluminal Implantation of Radioactive Stents for Treatment of Primary Carcinomas of the Peripancreatic-Head Region: A Pilot Study,” Gastrointestinal Endoscopy, Vol. 69, No. 6, 2009, pp. 1067-1073. http://dx.doi.org/10.1016/j.gie.2008.08.033
[35] K. T. Suk, J. W. Kim, H. S. Kim, S. K. Baik, S. J. Oh, S. J. Lee, H. G. Kim, D. H. Lee, Y. H. Won and D. K. Lee, “Human Application of a Metallic Stent Covered with a Paclitaxel-Incorporated Membrane for Malignant Biliary Obstruction: Multicenter Pilot Study,” Gastrointestinal Endoscopy, Vol. 66, No. 4, 2007, pp. 798-803. http://dx.doi.org/10.1016/j.gie.2007.05.037
[36] G. Morris-Stiff, A. Hassn and W. T. Young, “Self-Expanding Metal Stents for Duodenal Obstruction in Advanced Pancreatic Adenocarcinoma,” HPB (Oxford), Vol. 10, No. 2, 2008, pp. 134-137. http://dx.doi.org/10.1080/13651820801938891
[37] W. A. Ross. S. M. Wasan, D. B. Evans, R. A. Wolff, L. V. Trapani, G. A. Staerkel, T. Prindiville and J. H. Lee, “Combined EUS with FNA and ERCP for the Evaluation of Patients with Obstructive Jaundice from Presumed Pancreatic Malignancy,” Gastrointestinal Endoscopy, Vol. 68, No. 3, 2008, pp. 461-466. http://dx.doi.org/10.1016/j.gie.2007.11.033
[38] T. E. Yusuf, S. Ho, D. A. Pavey, H. Michael and F. G. Gress, “Retrospective Analysis of the Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUSFNA) in Pancreatic Masses, Using a 22-Gauge or 25-Gauge Needle System: A Multicenter Experience,” Endoscopy, Vol. 41, No. 5, 2009, pp. 445-448. http://dx.doi.org/10.1055/s-0029-1214643
[39] B. G. Turner, S. Cizginer, D. Agarwal, J. Yang, M. B. Pitman and W. R. Brugge, “Diagnosis of Pancreatic Neoplasia with EUS and FNA: A Report of Accuracy,” Gastrointestinal Endoscopy, Vol. 71, No. 1, 2010, pp. 91-98. http://dx.doi.org/10.1016/j.gie.2009.06.017
[40] T. M. O’Toole and N. Schmulewitz, “Complication Rates of EUS-Guided Celiac Plexus Blockade and Neurolysis: Results of a Large Case Series,” Endoscopy, Vol. 41 No. 7, 2009, pp. 593-597. http://dx.doi.org/10.1055/s-0029-1214868
[41] Z. Jin, Y. Du, Z. Li, Y. Jiang, J. Chen and Y. Liu, “Endoscopic Ultrasonography-Guided Interstitial Implantation of Iodine 125-Seeds Combined with Chemotherapy in the Treatment of Unresectable Pancreatic Carcinoma: A Prospective Pilot Study,” Endoscopy, Vol. 40, No. 4, 2008, pp. 314-320. http://dx.doi.org/10.1055/s-2007-995476
[42] J. R. Hecht, R. Bedford, J. L. Abbruzzese, S. Lahoti, T. R. Reid, R. M. Soetikno, D. H. Kirn and S. M. Freeman, “A Phase I/II Trial of Intratumoral Endoscopic Ultrasound Injection of ONYX-015 with Intravenous Gemcitabine in Unresectable Pancreatic Carcinoma,” Clinical Cancer Research, Vol. 9, No. 2, 2003, pp. 555-561.
[43] S. Mulvihill, R. Warren, A. Venook, A. Adler, B. Randlev, C. Heise and D. Kirn, “Safety and Feasibility of Injection with an E1B-55kDa Gene-Deleted, Replicationselective Adenovirus (ONYX-015) into Primary Carcinomas of the Pancreas: A Phase I Trial,” Gene Therapy, Vol. 8. No. 4, 2001, pp. 308-315. http://dx.doi.org/10.1038/sj.gt.3301398

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