Skip to main content
SpringerLink
Log in

Endoscopic Therapy: EUS-Based Therapy

  • Chapter
Pancreatic Masses

  • 1082 Accesses

Abstract

Since endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (FNA) emerged in 1992, it has become the standard technique for the differential diagnosis of pancreatic solid masses. Recently, several therapeutic EUS modalities have been developed for the treatment of pancreatic solid tumors, mainly pancreatic cancers. These therapeutic modalities are divided into three types: (1) injection therapy using alcohol, antitumor agents, and immunoreactive agents; (2) ablation therapy using radiofrequency, photodynamic therapy, ND:YAG laser therapy, and high-intensity focused ultrasound; (3) implantation using iodine-125 radioactive seeds, fiducial markers, and marking ink. Although the efficacies of these modalities are still debatable because most of the previous studies are retrospective and nonrandomized in nature, there are several possible advantages of these therapies over the standard therapy for pancreatic solid tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: A meta-analysis and systematic review. Pancreas. 2013;42:20–6.

    Article  PubMed  Google Scholar 

  2. Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992;38:172–3.

    Article  CAS  PubMed  Google Scholar 

  3. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol. 2002;97:1386–91.

    Article  PubMed  Google Scholar 

  4. Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–36.

    Article  PubMed  Google Scholar 

  5. Itoi T, Tsuchiya T, Itokawa F, et al. Histological diagnosis by EUS-guided fine-needle aspiration biopsy in pancreatic solid masses without on-site cytopathologist: a single-center experience. Dig Endosc. 2011;23 Suppl 1:34–8.

    Article  PubMed  Google Scholar 

  6. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008, cancer incidence and mortality worldwide: IARC cancer base no. 10. Lyon: International Agency for Research on Cancer. 2010. http://www.globocan.iarc.fr. Accessed May 2011.

  7. Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6:699–708.

    Article  PubMed  Google Scholar 

  8. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. Cancer J Clin. 2013;63(1):11–30.

    Article  Google Scholar 

  9. Gelczer RK, Charboneau JW, Hussain S, Brown DL. Complications of percutaneous ethanol ablation. J Ultrasound Med. 1998;17:531–3.

    CAS  PubMed  Google Scholar 

  10. Aslanian H, Salem RR, Marginean C, Robert M, Lee JH, Topazian M. EUS-guided ethanol injection of normal porcine pancreas: a pilot study. Gastrointest Endosc. 2005;62:723–7.

    Article  PubMed  Google Scholar 

  11. Matthes K, Mino-Kenudson M, Sahani DV, Holalkere N, Brugge WR. Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection. Gastrointest Endosc. 2007;65:272–7.

    Article  PubMed  Google Scholar 

  12. Jürgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stölzel U. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63:1059–62.

    Article  PubMed  Google Scholar 

  13. Muscatiello N, Salcuni A, Macarini L, Cignarelli M, Prencipe S, di Maso M, Castriota M, D’Agnessa V, Ierardi E. Treatment of a pancreatic endocrine tumor by ethanol injection guided by endoscopic ultrasound. Endoscopy. 2008;40 Suppl 2:E258–9.

    Article  PubMed  Google Scholar 

  14. Muscatiello N, Nacchiero M, Della Valle N, Di Terlizzi F, Verderosa G, Salcuni A, Macarini L, Cignarelli M, Castriota M, D’Agnessa V, Ierardi E. Treatment of a pancreatic endocrine tumor by ethanol injection (PEI) guided by endoscopic ultrasound. Endoscopy. 2008;40 Suppl 2:E83.

    Article  PubMed  Google Scholar 

  15. Deprez PH, Claessens A, Borbath I, Gigot JF, Maiter D. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroenterol Belg. 2008;71:333–7.

    PubMed  Google Scholar 

  16. Vleggaar FP, Bij de Vaate EA, Valk GD, Leguit RJ, Siersema PD. Endoscopic ultrasound-guided ethanol ablation of a symptomatic sporadic insulinoma. Endoscopy. 2011;43(Suppl 2) UCTN: E328–E329.

    Google Scholar 

  17. Levy MJ, Thompson GB, Topazian MD, Callstrom MR, Grant CS, Vella A. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc. 2012;75:200–6.

    Article  PubMed  Google Scholar 

  18. Hu YH, Tuo XP, Jin ZD, Liu Y, Guo Y, Luo L. Endoscopic ultrasound (EUS)-guided ethanol injection in hepatic metastatic carcinoma: a case report. Endoscopy. 2010;42 Suppl 2:E256–7.

    Article  PubMed  Google Scholar 

  19. Levy MJ, Alberts SR, Chari ST, et al. EUS guided intra-tumoral gemcitabine therapy for locally advanced and metastatic pancreatic cancer. Gastrointest Endosc. 2011;73:AB144–5.

    Google Scholar 

  20. Matthes K, Mino-Kenudson M, Sahani DV, et al. EUS-guided injection of paclitaxel (OncoGel) provides therapeutic drug concentrations in the porcine pancreas (with video). Gastrointest Endosc. 2007;65:448–53.

    Article  PubMed  Google Scholar 

  21. Hecht JR, Bedford R, Abbruzzese JL, et al. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res. 2003;9:555–61.

    CAS  PubMed  Google Scholar 

  22. Brennan GT, Relias V, Saif MW. Novel agents for the treatment of pancreatic cancer. J Pancreas. 2014;15:110–3.

    Google Scholar 

  23. Chang KJ, Nguyen PT, Thompson JA, et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88:1325–35.

    Article  CAS  PubMed  Google Scholar 

  24. Irisawa A, Takagi T, Kanazawa M, et al. Endoscopic ultrasound- guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas. 2007;35:189–90.

    Article  PubMed  Google Scholar 

  25. Hirooka Y, Itoh A, Kawashima H, et al. A combination therapy of gemcitabine with immunotherapy for patients with inoperable locally advanced pancreatic cancer. Pancreas. 2009;38:e69–74.

    Article  CAS  PubMed  Google Scholar 

  26. Cosman ER, Nashold BS, Ovelman-Levitt J. Theoretical aspects of radiofrequency lesions in the dorsal root entry zone. Neurosurgery. 1984;15:945–50.

    Article  CAS  PubMed  Google Scholar 

  27. Dolmans DE, Fukumura D, Jain RK. Photodynamic therapy for cancer. Nat Rev Cancer. 2003;3(5):380–7.

    Article  CAS  PubMed  Google Scholar 

  28. Chan HH, Nishioka NS, Mino M, et al. EUS-guided photodynamic therapy of the pancreas: a pilot study. Gastrointest Endosc. 2004;59:95–9.

    Article  PubMed  Google Scholar 

  29. Di Matteo F, Martino M, Rea R, et al. EUS-guided Nd:YAG laser ablation of normal pancreatic tissue: a pilot study in a pig model. Gastrointest Endosc. 2010;72:358–63.

    Article  PubMed  Google Scholar 

  30. Rukstalis DB. Treatment options after failure of radiation therapy: a review. Rev Urol. 2002;4 Suppl 2:S12–7.

    PubMed Central  PubMed  Google Scholar 

  31. Hwang J, Farr N, Morrison K, et al. Development of an EUS-guided high-intensity focused ultrasound endoscope. Gastrointest Endosc. 2011;73:AB155.

    Article  Google Scholar 

  32. Pishvaian AC, Collins B, Gagnon G, Ahlawat S, Haddad NG. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc. 2006;64:412–7.

    Article  PubMed  Google Scholar 

  33. Varadarajulu S, Trevino JM, Shen S, Jacob R. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy. 2010;42:423–5.

    Article  CAS  PubMed  Google Scholar 

  34. Park WG, Yan BM, Schellenberg D, et al. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc. 2010;71:513–8.

    Article  PubMed  Google Scholar 

  35. DiMaio CJ, Nagula S, Goodman KA, et al. EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos). Gastrointest Endosc. 2010;71:1204–10.

    Article  PubMed  Google Scholar 

  36. Sanders MK, Moser AJ, Khalid A, et al. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc. 2010;71:1178–84.

    Article  PubMed  Google Scholar 

  37. Ammar T, Coté GA, Creach KM, et al. Fiducial placement for stereotactic radiation by using EUS: feasibility when using a marker compatible with a standard 22-gauge needle. Gastrointest Endosc. 2010;71:630–3.

    Article  PubMed  Google Scholar 

  38. Khashab MA, Kim KJ, Tryggestad EJ, et al. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc. 2012;76:962–71.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Choi JH, Seo DW, Park DH, Lee SK, Kim MH. Fiducial placement for stereotactic body radiation therapy under only endoscopic ultrasonography guidance in pancreatic and hepatic malignancy: practical feasibility and safety. Gut Liver. 2014;8:88–93.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Dávila Fajardo R, Lekkerkerker SJ, van der Horst A, Lens E, Bergman JJ, Fockens P, Bel A, van Hooft JE. EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. Gastrointest Endosc. 2014;79:851. doi:10.1016/j.gie.2013.12.027. pii: S0016-5107(13)02710-7.

    Article  PubMed  Google Scholar 

  41. Majumder S, Berzin TM, Mahadevan A, et al. Endoscopic ultrasound guided pancreatic fiducial placement: how important is ideal fiducial geometry? Pancreas. 2013;42:692–5.

    Article  PubMed  Google Scholar 

  42. Taira AV, Merrick GS, Butler WM, Galbreath RW, Lief J, Adamovich E, Wallner KE. Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2011;79:1336–42.

    Article  PubMed  Google Scholar 

  43. Sun S, Xu H, Xin J, et al. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy. 2006;38:399–403.

    Article  CAS  PubMed  Google Scholar 

  44. Jin Z, Du Y, Li Z, et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study. Endoscopy. 2008;40:314–20.

    Article  CAS  PubMed  Google Scholar 

  45. Du Y, Jin Z, Meng H, Zou D, Chen J, Liu Y, Zhan X, Wang D, Liao Z, Li Z. Long-term effect of gemcitabine-combined endoscopic ultrasonography-guided brachytherapy in pancreatic cancer. J Interv Gastroenterol. 2013;3:18–24.

    Article  Google Scholar 

  46. Gress FG, Barawi M, Kim D, Grendell JH. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest Endosc. 2002;55(4):594–7.

    Article  PubMed  Google Scholar 

  47. Ashida R, Yamao K, Okubo K, Sawaki A, Mizuno N, Nakamura T, Tajika M, Kawai H, Shimizu Y. Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy. 2006;38(2):190–2.

    Article  CAS  PubMed  Google Scholar 

  48. Farrell JJ, Sherrod A, Parekh D. EUS-guided fine-needle tattooing for preoperative localization of early pancreatic adenocarcinoma. Gastrointest Endosc. 2009;69(1):176–7.

    Article  PubMed  Google Scholar 

  49. Lennon AM, Newman N, Makary MA, Edil BH, Shin EJ, Khashab MA, Hruban RH, Wolfgang CL, Schulick RD, Giday S, Canto MI. EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc. 2010;72(5):1089–94.

    Article  PubMed  Google Scholar 

  50. Larsen MH, Fristrup CW, Mortensen MB. Endoscopic ultrasound-guided fine-needle marking of a small pancreatic tumor. Endoscopy. 2009;41 Suppl 2:E175–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Thanks are due to Dr. Edward Barroga for reviewing and editing this chapter.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan

    Takao Itoi M.D., Ph.D., F.A.S.G.E.

Authors
  1. Takao Itoi M.D., Ph.D., F.A.S.G.E.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takao Itoi M.D., Ph.D., F.A.S.G.E. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Mihir S. Wagh

  2. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Peter V. Draganov

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Itoi, T. (2016). Endoscopic Therapy: EUS-Based Therapy. In: Wagh, M., Draganov, P. (eds) Pancreatic Masses. Springer, Cham. https://doi.org/10.1007/978-3-319-19677-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19677-0_21

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19676-3

  • Online ISBN: 978-3-319-19677-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation