Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer

Simple Summary Complications of pancreatic cancer include the development of blockage of the bile duct preventing drainage of the liver, blockage of the stomach and duodenum preventing the passage of food and increase in pain levels. Endoscopic ultrasound is a procedure performed through the mouth where a flexible tube with a camera and an ultrasound probe attached allow for visualization of organs around the stomach and small intestine, such as the pancreas, the bile duct, and the liver. It was originally designed to help diagnose pancreatic cancer, but with advances in technology, it can now be used to treat the aforementioned complications without performing surgery. This paper reviews the new advances in technologies and techniques performed through endoscopic ultrasound with an emphasis on clinical trials that have been done to provide an overview of the safety and effectiveness of these procedures.Abstract Progression of pancreatic adenocarcinoma can result in disease complications such as biliary obstruction and gastric outlet obstruction. The recent advances in endoscopic ultrasound (EUS) have transformed EUS from a purely diagnostic technology to a therapeutic modality, particularly with the development of lumen-apposing metal stents. In terms of biliary drainage, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy offer safe and effective techniques when conventional transpapillary stent placement via ERCP fails or is not possible. If these modalities are not feasible, EUS-guided gallbladder drainage offers yet another salvage technique when the cystic duct is non-involved by the cancer. Lastly, EUS-guided gastroenterostomy allows for an effective bypass treatment for cases of gastric outlet obstruction that enables patients to resume eating within several days. Future randomized studies comparing these techniques to current standard-of-care options are warranted to firmly establish therapeutic EUS procedures within the treatment algorithm for this challenging disease.