Endoscopic Therapy of Solid and Cystic Neoplasms of the Pancreas

Endoscopic ultrasound (EUS) has evolved as a powerful endoscopic tool with a variety of applications for the assessment, and increasingly, treatment of abdominal diseases. EUS has progressively improved as an interventional procedure with applications in pancreaticobiliary access, treatment of pancreatic fluid collections and necrosis, gallbladder drainage, gastrojejunostomy, and endohepatology. Here we address interventional EUS and its role in pancreatic cyst ablation as well as EUS-guided solid tumor ablation and treatment. EUS-guided pancreatic cyst chemoablation has been shown to be an effective, safe, and durable option for the treatment of appropriately selected, mucinous-type, pancreatic cysts when approached as part of a high volume multidisciplinary program. In the treatment of solid pancreatic lesions, multiple endoscopic therapies have shown promise with most attention focused on the treatment of pancreatic neuroendocrine tumors. More advanced tumors and malignancies have also been treated with encouraging, but limited, results, and this area of interventional EUS is in need of prospective studies with standardized definitions of safety and treatment responses as development continues.