The Roles of Endoscopy in the Diagnosis and Treatment of Pancreatic Cancer

Pancreatic carcinoma is the 8th leading cause of cancer deaths in Taiwan, with rising incidence and mortality rates. Endoscopic procedures including endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) play important roles in the detection, staging and diagnosis of pancreatic cancer and palliation of tumor-related complications. EUS is the most sensitive modality for detecting pancreatic tumor, and is very useful in evaluating the size of the tumor and the extent of invasion into adjacent organs and vessels. EUS-guided fine needle aspiration (EUS-FNA) allows sampling of the tumor and is the method of choice for tissue diagnosis of pancreatic cancer, with sensitivity and specificity approaching 90%. Celiac plexus neurolysis, which injects alcohol to destroy celiac plexus under EUS guidance, achieves effective palliation for pain caused by advanced pancreatic cancer. Pancreatic cancer frequently results in distal biliary obstruction/jaundice and gastric outlet obstruction. ERCP with placement of biliary stent is the method of choice for biliary drainage. If ERCP fails, biliary drainage can also be achieved by biliary stenting under EUS guidance. Endoscopic placement of an enteral stent offers effective palliation of gastric outlet obstruction and is less invasive than enteral bypass surgery.