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Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses.

Kim J - Clin Endosc (2015)

Bottom Line: Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics.Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer.Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics. Recently, there have been several innovative trials on the treatment of pancreatic tumors using endoscopic ultrasound (EUS) because it allows selective access to the difficult to reach target organ along the gastrointestinal tract and can differentiate vessels by color Doppler. Among these trials, several have investigated EUS-guided ethanol lavage with or without paclitaxel for pancreatic cystic tumors. These studies show a 33% to 79% complete resolution rate with a favorable safety profile. Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer. Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

No MeSH data available.


Related in: MedlinePlus

Endoscopic ultrasound-guided ethanol lavage. (A) The cyst is punctured by a fine needle. (B) Subtotal evacuation of the cystic fluid is performed. (C) Injection of ethanol (blue), which equals to that of aspiration, is performed.
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Figure 1: Endoscopic ultrasound-guided ethanol lavage. (A) The cyst is punctured by a fine needle. (B) Subtotal evacuation of the cystic fluid is performed. (C) Injection of ethanol (blue), which equals to that of aspiration, is performed.

Mentions: Percutaneous ethanol lavage has been used in the liver,6 kidney,7 and thyroid gland8 for a long time and is established as a safe and effective treatment. Ethanol is inexpensive, widely available, and little viscous. Theoretical mechanisms of ethanol lavage are lysis of the cyst membrane, protein denaturation, and vascular occlusion. Based on experience with percutaneous ethanol injection, pancreatic tissue ablation by EUS-EL was studied. The technique used was as follows: the cyst was punctured via a transduodenal or transgastric route and cystic fluid aspiration was performed using a curvilinear array echoendoscope and 22-gauge needle. After subtotal evacuation of cystic fluid, injection of ethanol, which equals to that of aspiration, was performed (Fig. 1). Then, lavage of the cyst was performed for 3 to 5 minutes. In some studies, an additional paclitaxel injection was administered after the final ethanol lavage; paclitaxel is a well-known chemotherapeutic agent that inhibits microtubule dependent cell division and because of its hydrophobic and viscous nature, it was expected to be retained in the cyst without leakage.


Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses.

Kim J - Clin Endosc (2015)

Endoscopic ultrasound-guided ethanol lavage. (A) The cyst is punctured by a fine needle. (B) Subtotal evacuation of the cystic fluid is performed. (C) Injection of ethanol (blue), which equals to that of aspiration, is performed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522422&req=5

Figure 1: Endoscopic ultrasound-guided ethanol lavage. (A) The cyst is punctured by a fine needle. (B) Subtotal evacuation of the cystic fluid is performed. (C) Injection of ethanol (blue), which equals to that of aspiration, is performed.
Mentions: Percutaneous ethanol lavage has been used in the liver,6 kidney,7 and thyroid gland8 for a long time and is established as a safe and effective treatment. Ethanol is inexpensive, widely available, and little viscous. Theoretical mechanisms of ethanol lavage are lysis of the cyst membrane, protein denaturation, and vascular occlusion. Based on experience with percutaneous ethanol injection, pancreatic tissue ablation by EUS-EL was studied. The technique used was as follows: the cyst was punctured via a transduodenal or transgastric route and cystic fluid aspiration was performed using a curvilinear array echoendoscope and 22-gauge needle. After subtotal evacuation of cystic fluid, injection of ethanol, which equals to that of aspiration, was performed (Fig. 1). Then, lavage of the cyst was performed for 3 to 5 minutes. In some studies, an additional paclitaxel injection was administered after the final ethanol lavage; paclitaxel is a well-known chemotherapeutic agent that inhibits microtubule dependent cell division and because of its hydrophobic and viscous nature, it was expected to be retained in the cyst without leakage.

Bottom Line: Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics.Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer.Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics. Recently, there have been several innovative trials on the treatment of pancreatic tumors using endoscopic ultrasound (EUS) because it allows selective access to the difficult to reach target organ along the gastrointestinal tract and can differentiate vessels by color Doppler. Among these trials, several have investigated EUS-guided ethanol lavage with or without paclitaxel for pancreatic cystic tumors. These studies show a 33% to 79% complete resolution rate with a favorable safety profile. Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer. Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

No MeSH data available.


Related in: MedlinePlus