2024 American Guidelines for Solid Pancreatic Masses: Advanced Care with EUS and ERCP

 
Pancreatic cancer remains one of the most aggressive and deadliest cancers worldwide. High mortality rates are largely due to late diagnosis and rapid progression. Early detection and timely treatment are critical for improving patient outcomes, but they remain challenging in clinical practice.
 
In response, the American Society for Gastrointestinal Endoscopy (ASGE) has released updated 2024 guidelines that focus on improving the role of endoscopy in diagnosing and managing solid pancreatic masses. These updates are especially significant as pancreatic cancer continues to rank among the leading causes of cancer-related deaths globally.
 
This article breaks down the key recommendations from the 2024 ASGE guidelines and highlights how Bumrungrad International Hospital applies cutting-edge technologies like ERCP and EUS to deliver world-class pancreatic cancer care.

 

What Are ERCP and EUS?

If you are unfamiliar with these procedures, here is a quick overview:
 

• Endoscopic Retrograde Cholangiopancreatography (ERCP):
  ERCP is a minimally invasive procedure that combines endoscopy and real-time X-ray imaging to examine and treat conditions of the bile ducts, pancreas, and gallbladder. It is commonly used for:
  • Removing blockages or obstructions in the biliary or pancreatic ducts.
  • Taking biopsies for tissue diagnosis.
  • Placing stents to relieve biliary obstructions caused by tumors.

The procedure involves inserting a thin, flexible endoscope through the mouth, navigating to the digestive tract, and into the bile ducts for diagnostic and therapeutic purposes.
 

• Endoscopic Ultrasound (EUS):
  EUS integrates endoscopy with ultrasound technology to produce highly detailed and precise images of the pancreas and surrounding organs. This allows doctors to:
  • Accurately diagnose pancreatic masses at early stages.
  • Perform Fine-Needle Aspiration (FNA) or Fine-Needle Biopsy (FNB) for precise tissue sampling.

At Bumrungrad International Hospital, we utilize state-of-the-art technology for both ERCP and EUS, enabling us to diagnose and manage pancreatic cancer effectively while improving patient outcomes.
 

 

Key Takeaways from the 2024 ASGE Guidelines

The updated ASGE guidelines provide critical recommendations for managing solid pancreatic masses. Here are the highlights:
 
1. Endoscopic Ultrasound (EUS) and Tissue Acquisition (TA):
The guidelines emphasize the pivotal role of EUS in diagnosing solid pancreatic masses.

• Fine-Needle Biopsy (FNB):
  • FNB is now recommended over Fine-Needle Aspiration (FNA) because it delivers higher-quality tissue samples for accurate diagnosis and staging.
  • Among available options, the 22-gauge FNB needle is considered the gold standard for obtaining tissue samples from pancreatic masses.

EUS not only facilitates early detection of pancreatic cancer but also supports accurate tumor staging, enabling timely intervention and better survival rates.
 
2. Rapid On-Site Evaluation (ROSE):

• What is ROSE?
  • ROSE involves real-time evaluation of tissue samples during the biopsy to ensure adequate sampling.
• Updated Recommendation:
  • While previously common, the guidelines now advise against the routine use of ROSE, as studies indicate it does not significantly improve diagnostic outcomes.

At Bumrungrad, this update streamlines the biopsy process, reducing the number of passes required, ensuring patient comfort, and maintaining diagnostic precision.
 
3. ERCP and Stent Placement for Malignant Biliary Obstruction:

• Tumors in pancreatic cancer often obstruct bile ducts, causing bile to build up and leading to jaundice.
• Updated Stent Recommendations:
  • The ASGE recommends self-expanding metal stents (SEMS) over plastic stents for long-term relief of biliary obstruction.
  • Covered SEMS (cSEMS) are preferred due to their reduced risk of migration and lower complication rates.

ERCP with SEMS placement offers effective and sustained relief for patients experiencing jaundice or other bile duct complications caused by pancreatic tumors.
 
4. Celiac Plexus Neurolysis (CPN) for Pain Management:
Pancreatic cancer frequently causes severe abdominal pain, particularly in advanced stages.

• Updated Recommendation:
  • The ASGE supports the use of Celiac Plexus Neurolysis (CPN) for managing pancreatic cancer-related pain.
  • CPN involves injecting medications to block nerve signals from the abdominal region, offering significant pain relief and improving the quality of life for patients with unresectable pancreatic cancer.

 
 

Why Choose Bumrungrad International Hospital for Pancreatic Cancer Care?

Bumrungrad International Hospital is a global leader in diagnosing and treating pancreatic cancer, offering advanced endoscopic techniques and personalized care. Here is why patients trust us:
 

1. Advanced Endoscopy Expertise:
   • Our specialists are internationally recognized for their skills in ERCP and EUS. Using the latest 22-gauge FNB needles, we provide precise tissue sampling for accurate diagnoses and early intervention.
2. Minimally Invasive Techniques:
   • We prioritize minimally invasive procedures like EUS-guided CPN and SEMS placement, reducing recovery times and improving outcomes while minimizing discomfort.
3. Tailored Treatment Plans:
   • Every patient receives a customized care plan, from selecting the most appropriate stents for biliary obstructions to incorporating advanced therapies for pain management.
4. Global Collaborations:
   • Bumrungrad partners with leading medical institutions like Harvard Medical School, Johns Hopkins Hospital, and Mayo Clinic, ensuring our patients benefit from the latest advancements in pancreatic cancer care.
5. Global Recognition and Trust:
   • Known for its innovation and patient-centered approach, Bumrungrad is trusted by patients worldwide for its excellence in gastrointestinal care.

 
 

Innovations at Bumrungrad: A Look toward the Future

The 2024 ASGE guidelines also highlight promising research areas, including:

• EUS-Guided Intratumoral Therapy: Delivering treatments directly into pancreatic tumors.
• Gene Transfer and Radiofrequency Ablation: Cutting-edge therapies under exploration for better cancer control.

Bumrungrad actively participates in clinical trials, giving our patients access to innovative treatments as they become available.
 

Conclusion

The 2024 ASGE guidelines mark a turning point in the diagnosis and management of solid pancreatic masses, emphasizing advanced endoscopic techniques like ERCP and EUS.
 

At Bumrungrad International Hospital, we integrate these recommendations into our clinical practices, combining state-of-the-art technology with personalized care to deliver the best possible outcomes for patients.
 
If you or a loved one is seeking advanced pancreatic cancer care, Bumrungrad is here to help. Contact us today to learn more about our cutting-edge diagnostic tools and treatment options.
 

Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital