內視鏡於胰臟癌診斷與治療之角色

The Roles of Endoscopy in the Diagnosis and Treatment of Pancreatic Cancer

胰臟癌（pancreatic carcinoma）為國人第8大癌症死因，其發生率及死亡率逐年增加。內視鏡超音波（endoscopic ultrasound, EUS）、內視鏡逆行性膽胰管攝影（endoscopic retrograde cholangiopancreatography, ERCP）等內視鏡檢查對於胰臟癌的偵測、期別區分、診斷以及併發症之處置有重要的應用。內視鏡超音波是偵測胰臟腫瘤敏感度最高的檢查，對於評估腫瘤之範圍及對周邊器官與血管之影響程度有重要價值藉由內視鏡超音波指引細針抽吸（EUS-guided fine needle aspiration）也可取得組織進行細胞學化驗，其診斷胰臟癌之敏感度與特異度高達9成，是最佳的獲取胰臟組織診斷之方法。對於末期胰臟癌引發之嚴重疼痛，藉由內視鏡超音波導引注射酒精破壞腹腔神經叢可有效地減輕疼痛。胰臟癌常導致總膽管阻塞/黃疸及胃出口阻塞。藉由內視鏡逆行性膽胰管攝影置入膽道支架是首選的引流方式。若是內視鏡逆行性膽胰管攝影失敗，也可藉由內視鏡超音波指引進入膽管來置入膽管支架。對於胰臟癌導致之胃出口阻塞，利用內視鏡於阻塞處置入腸道支架也可有效緩解腸道阻塞，其侵襲性較腸道繞道手術為低。

Pancreatic carcinoma is the 8th leading cause of cancer deaths in Taiwan, with rising incidence and mortality rates. Endoscopic procedures including endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) play important roles in the detection, staging and diagnosis of pancreatic cancer and palliation of tumor-related complications. EUS is the most sensitive modality for detecting pancreatic tumor, and is very useful in evaluating the size of the tumor and the extent of invasion into adjacent organs and vessels. EUS-guided fine needle aspiration (EUS-FNA) allows sampling of the tumor and is the method of choice for tissue diagnosis of pancreatic cancer, with sensitivity and specificity approaching 90%. Celiac plexus neurolysis, which injects alcohol to destroy celiac plexus under EUS guidance, achieves effective palliation for pain caused by advanced pancreatic cancer. Pancreatic cancer frequently results in distal biliary obstruction/jaundice and gastric outlet obstruction. ERCP with placement of biliary stent is the method of choice for biliary drainage. If ERCP fails, biliary drainage can also be achieved by biliary stenting under EUS guidance. Endoscopic placement of an enteral stent offers effective palliation of gastric outlet obstruction and is less invasive than enteral bypass surgery.