EUS-guided local therapies

Endoscopic ultrasound (EUS) has gradually evolved from purely a diagnostic procedure to an interventional and therapeutic modality for many gastrointestinal malignancies. The aim of this chapter is to describe the emerging role of EUS in the guidance of tumor-targeted therapies for patients with PDAC. Interventional EUS involving direct injection of anti-tumor agents, radiation, and ablative energy has gained increasing interest in the destruction of pancreatic tumor cells because of the inability of systemic chemotherapy to penetrate through the dense stroma of PDAC. Many of these EUS procedures have been shown to be feasible, safe, and well tolerated with short-term efficacy. The long-term clinical effectiveness and survival improvement of these proposed EUS therapies is yet to be proven and will need randomized control trials to confirm their clinical impact on PDAC.