췌장암은 예후가 불량하며, 수술적 절제를 통해서만 완치를 기대할 수 있으나 20% 내외의 환자만이 근치적 절제가 가능한 병기에서 진단이 된다. 또한 전신 항암화학치료에 대한 반응도 좋지 않아 항암화학 요법의 개선에도 불구하고 절제 불가능한 췌장암의 예후는 특히 불량하다. 국소진행성 췌장암의 경우 조기의 적극적인 치료로 종양의 용적을 감소시켜 병기를 낮출 수 있다면 수술적 치료가 가능해질 가능성이 있기 때문에 전신 항암화학요법과 병행하는 내시경적 국소 치료의 중요성이 더욱 높다고 할 수 있다. 국소 치료의 종류로는 항암제나 바이러스 벡터를 종양에 주입하는 EUS-FNI와 RFA, IRE 등의 국소 종양 제거술(local ablative therapy), 정위적 방사선 치료를 위한 표식자 삽입(fiducial marker insertion), 악성 담도 폐쇄 시 삽입한 스텐트 기능 유지를 위한 약물-배출 스텐트 삽입 등이 있다.

Pancreatic adenocarcinoma is one of the cancers with the poorest prognosis, and its incidence has gradually increased to become the 9th most common cancer in Korea in 2016. Surgical resection is the only treatment option to improve the cure and longterm survival rate. Unfortunately, only 10% to 20% of all pancreatic cancer patients present with resectable disease, because of common symptoms are rarely noticeable in its early stages and disease progress very quickly. Unresectable pancreatic cancer can be divided into locally advanced pancreatic cancer (LAPC) and metastatic disease. Pancreatic cancer with distant metastasis accounts for about 40–60% of the total pancreatic cancer and systemic chemotherapy is considered as standard treatment. LAPC is observed in 30–40%, defined as the tumor surrounding major blood vessels (especially, celiac artery and superior mesenteric artery) more than 180° without distant metastasis which cannot be completely removed by surgery. Standard treatment for LAPC has not yet been established, and chemotherapy and radiotherapy have mainly been used, but in most cases, response to these therapeutic options has been limited. As imaging techniques, endoscopic devices and procedures have recently been developed and the role of local endoscopic therapies for LAPC has expanded. This article provides an overview of local endoscopic treatment for LAPC such as injection therapy, radiofrequency ablation (RFA), irreversible electroporation (IRE), radiotherapy and drug-delivery stent insertion.

서 론
본 론
    1. EUS 유도하 세침 주입술
    2. 국소 종양 제거술
    3. 방사선 치료
    4. 약물방출 스텐트
결 론
요 약
REFERENCES

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