Marques Susana, Bispo Miguel, Leite Sílvia, Moreira Teresa, Caldeira Ana, Moutinho-Ribeiro Pedro, Nunes Nuno
Department of Gastroenterology and Digestive Endoscopy, Champalimaud Foundation, Lisbon, Portugal.
Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.
GE Port J Gastroenterol. 2021 Feb;28(2):106-110. doi: 10.1159/000509194. Epub 2020 Jul 28.
In the last 2 decades, endoscopic ultrasound (EUS) has become an important procedure for the diagnosis and management of several pancreatic diseases, including pancreatic cancer. This article presents two recently developed EUS-guided techniques for the management of pancreatic cancer: fine-needle tattooing and fiducial placement. Preoperative EUS-guided fine-needle tattooing of small pancreatic tumors helps in precise localization of these lesions during surgery, potentially ensuring adequate margins of resection while preserving healthy pancreatic tissue. In pancreatic cancer patients planned for imaging-guided radiation therapy, EUS-guided fiducial placement improves the accuracy of target delineation during stereotactic body radiation therapy (SBRT). Hydrogel, a new injectable liquid with multimodal visibility recently approved as a liquid fiducial, is currently under investigation in pancreatic head cancer as an EUS-injected spacer to potentially reduce SBRT gastrointestinal wall toxicity. In this article, GRUPUGE presents an updated perspective of these two EUS-guided techniques, addressing their current clinical applications and technical aspects and analyzing existing data on their efficacy and safety.
在过去20年里，内镜超声（EUS）已成为诊断和管理包括胰腺癌在内的多种胰腺疾病的重要手段。本文介绍了两种最近开发的用于胰腺癌管理的EUS引导技术：细针纹身和基准点放置。术前对小胰腺肿瘤进行EUS引导下细针纹身有助于在手术期间精确定位这些病变，有可能在保留健康胰腺组织的同时确保足够的切除边缘。对于计划接受影像引导放射治疗的胰腺癌患者，EUS引导下基准点放置可提高立体定向体部放射治疗（SBRT）期间靶区勾画的准确性。水凝胶是一种最近被批准作为液体基准点的具有多模态可视性的新型可注射液体，目前正在胰腺癌中作为EUS注射间隔物进行研究，以潜在降低SBRT对胃肠道壁的毒性。在本文中，GRUPUGE对这两种EUS引导技术提出了最新观点，阐述了它们当前的临床应用和技术方面，并分析了关于其疗效和安全性的现有数据。
