Pancreatic Cancer Surveillance in STK11 Mutation Carriers with Peutz-Jeghers Syndrome: The Role of Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in Early Neoplasia Detection

Background: Peutz-Jeghers Syndrome (PPS), an autosomal dominant disorder caused by pathogenic variants in the STK11/LKB1 tumor suppressor gene, confers a significantly elevated lifetime risk of gastrointestinal (GI) and extraintestinal malignancies, including pancreatic ductal adenocarcinoma (PDAC). Current guidelines lack consensus on optimal surveillance strategies for PDAC in this high-risk cohort. Aims: This article evaluates the efficacy of advanced endoscopic modalities—specifically EUS and ERCP—in the early detection of pancreatic neoplasia in STK11 carriers, addressing procedural benefits, limitations, and evidence-based screening intervals. Methods: A systematic review of literature from PubMed, EMBASE, and Cochrane databases (2000–2023) was conducted, focusing on PPS-related PDAC, STK11 penetrance, and endoscopic screening outcomes. Results: EUS demonstrates superior sensitivity for pancreatic parenchymal abnormalities (e.g., cystic lesions, hypoechoic nodules) compared to cross-sectional imaging. ERCP complements EUS by evaluating ductal abnormalities (e.g., strictures, intraductal papillary mucinous neoplasms/IPMNs). However, procedural risks (e.g., post-ERCP pancreatitis) necessitate careful patient selection. Conclusion: Multimodal surveillance incorporating EUS ± ERCP may mitigate PDAC mortality in STK11 carriers, though prospective studies are needed to standardize protocols.