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.
胰腺腺癌的进展可能导致胆道梗阻和胃出口梗阻等疾病并发症。内镜超声（EUS）技术的最新进展已使其从单纯的诊断工具转变为治疗手段，特别是随着管腔贴合金属支架的发展。在胆道引流方面，当传统经内镜逆行胰胆管造影术（ERCP）的经乳头支架置入失败或无法实施时，EUS引导下的胆总管十二指肠吻合术和肝胃吻合术提供了安全有效的技术选择。若上述方法不可行，在胆囊管未受肿瘤侵犯的情况下，EUS引导的胆囊引流术可作为另一种补救技术。最后，对于胃出口梗阻病例，EUS引导下的胃肠吻合术能实现有效的旁路治疗，使患者在数日内恢复进食。未来需要通过随机对照研究，将这些技术与当前标准治疗方案进行比较，以在治疗这一棘手疾病的临床路径中确立治疗性EUS操作的稳固地位。
Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer
肿瘤(癌症)患者之家