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Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation.
Acta Medica (Hradec Kralove). 2019; 62(4):131-136.AM

Abstract

Pancreatic cancer is the seventh leading cause of cancer deaths worldwide and is associated with a poor survival rate. The vast majority of pancreatic cancers are inoperable at the time of diagnosis. In the absence of metastatic disease, operability depends on the extent of local disease; in particular, the presence or absence of vascular and lymph node involvement. Adequate staging is vital in deciding an appropriate treatment plan. Cross sectional imaging including CT, MRI and PET-CT are commonly used for staging. However, EUS is a useful adjunct for accurate loco-regional staging in addition to allowing diagnostic tissue samples to be obtained. Emerging EUS-guided therapeutic techniques have opened up new horizons in the management of pancreatic malignancy. EUS guidance can be used for coeliac plexus neurolysis in patients with intractable pain and fiducial placement in directing stereotactic radiotherapy. The majority of patients with cancer of the pancreatic head present with biliary obstruction. ERCP can be used to drain the obstructed biliary system with plastic or metal stents and offers an opportunity to confirm the diagnosis by obtaining brush cytology and forceps biopsy specimens. EUS-guided choledocho-duodenostomy or hepatico-gastrostomy is increasingly being employed for draining the biliary system if ERCP is unsuccessful.

Authors+Show Affiliations

The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, Chelsea, SW3 6JJ, London, United Kingdom.The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, Chelsea, SW3 6JJ, London, United Kingdom. Darina.Kohoutova@rmh.nhs.uk. 2nd Department of Internal Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Hospital, Hradec Králové, Czech Republic. Darina.Kohoutova@rmh.nhs.uk.2nd Department of Internal Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Hospital, Hradec Králové, Czech Republic.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32036844

Citation

Zar, Sameer, et al. "Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation." Acta Medica (Hradec Kralove), vol. 62, no. 4, 2019, pp. 131-136.
Zar S, Kohoutová D, Bureš J. Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation. Acta Medica (Hradec Kralove). 2019;62(4):131-136.
Zar, S., Kohoutová, D., & Bureš, J. (2019). Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation. Acta Medica (Hradec Kralove), 62(4), 131-136. https://doi.org/10.14712/18059694.2020.1
Zar S, Kohoutová D, Bureš J. Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation. Acta Medica (Hradec Kralove). 2019;62(4):131-136. PubMed PMID: 32036844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation. AU - Zar,Sameer, AU - Kohoutová,Darina, AU - Bureš,Jan, PY - 2020/2/11/entrez PY - 2020/2/11/pubmed PY - 2020/7/9/medline KW - ERCP KW - endoscopic ultrasound KW - pancreatic adenocarcinoma SP - 131 EP - 136 JF - Acta medica (Hradec Kralove) JO - Acta Medica (Hradec Kralove) VL - 62 IS - 4 N2 - Pancreatic cancer is the seventh leading cause of cancer deaths worldwide and is associated with a poor survival rate. The vast majority of pancreatic cancers are inoperable at the time of diagnosis. In the absence of metastatic disease, operability depends on the extent of local disease; in particular, the presence or absence of vascular and lymph node involvement. Adequate staging is vital in deciding an appropriate treatment plan. Cross sectional imaging including CT, MRI and PET-CT are commonly used for staging. However, EUS is a useful adjunct for accurate loco-regional staging in addition to allowing diagnostic tissue samples to be obtained. Emerging EUS-guided therapeutic techniques have opened up new horizons in the management of pancreatic malignancy. EUS guidance can be used for coeliac plexus neurolysis in patients with intractable pain and fiducial placement in directing stereotactic radiotherapy. The majority of patients with cancer of the pancreatic head present with biliary obstruction. ERCP can be used to drain the obstructed biliary system with plastic or metal stents and offers an opportunity to confirm the diagnosis by obtaining brush cytology and forceps biopsy specimens. EUS-guided choledocho-duodenostomy or hepatico-gastrostomy is increasingly being employed for draining the biliary system if ERCP is unsuccessful. SN - 1805-9694 UR - https://www.unboundmedicine.com/medline/citation/32036844/Pancreatic_Adenocarcinoma:_Epidemiology_Role_of_EUS_in_Diagnosis_Role_of_ERCP_Endoscopic_Palliation_ L2 - https://actamedica.lfhk.cuni.cz/fulltext/?doi=10.14712/18059694.2020.1 DB - PRIME DP - Unbound Medicine ER -