Últimos avances sobre los tumores pancreáticos | Gastroenterología y Hepatología

Información del artículo

Resumen

El cáncer de páncreas (CP) continúa siendo una entidad de pésimo pronóstico. Aparecen estudios epidemiológicos que sugieren nuevos factores protectores de la enfermedad, como el consumo de aspirina y ácido oleico. La ultrasonografía endoscópica (USE) continúa siendo el pilar fundamental diagnóstico, surgiendo avances asociados a ella, como el empleo de la elastografía cuantitativa (coeficiente de elasticidad o strain ratio y el análisis por histograma de colores) y los contrastes por vía intravenosa, así como el desarrollo de nuevas agujas para obtención de material histológico (pro-core), que intervienen en el diagnóstico diferencial. Como novedad para años venideros surge la endomicroscopía confocal para el diagnóstico del CP y de los tumores quísticos, utilizada mediante una sonda a través de la aguja de 19G de ecoendoscopia. En el campo terapéutico aparecen estudios que evalúan la seguridad y la eficacia de la administración intratumoral de gemcitabina mediante USE-punción inyección. En relación con los tumores quísticos, el tumor mucinoso papilar intraductal continúa siendo el más estudiado, apareciendo estudios que evalúan determinados criterios de trasformación maligna y analizan la historia natural de esta neoplasia.

Palabras clave:

Cáncer de páncreas

Tumor mucinoso papilar intraductal

Tumores quísticos pancreáticos

Ultrasonografía endoscópica

Abstract

Pancreatic cancer (PC) continues to have a poor prognosis. New epidemiological trials have suggested that there may be protective factors, such as aspirin or oleic acid intake. The main diagnostic tool for PC is endoscopic ultrasound (EUS), and new EUSrelated technologies have appeared, such as quantitative elastography (strain ratio and hue histogram analysis), intravenous contrasts, and the new procore needles to help in the differential diagnosis with other diseases (mainly chronic pancreatitis). In the next few years, intratumoral confocal endomicroscopy will be used for the diagnosis of PC and cystic tumors, by inserting a miniprobe inside the 19G needle of the echoendoscope.

Notable therapeutic developments are studies on the safety, feasibility and accuracy of intratumoral gemcitabine administration by EUS-fine needle injection in the treatment of locally advanced PC. In the treatment of cystic tumors of the pancreas, mainly intraductal papillary mucinous neoplasms (IPMN), most studies aim to optimize follow up by assessing predictive factors of malignant transformation and evaluating the natural history of this neoplasm.

Keywords:

Pancreatic cancer

Intraductal papillary mucinous neoplasm

Pancreatic cystic tumors

Endoscopic ultrasound

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