Endoscopic ultrasound-guided ablation of pancreatic cystic neoplasms: ready for prime time?

Andrew Ofosu, Daryl Ramai, Douglas G Adler, Andrew Ofosu, Daryl Ramai, Douglas G Adler

Abstract

With the increase in the use of cross-sectional diagnostic imaging, there has been a concomitant rise in the rate of detected pancreatic cystic lesions. Recent years have seen the rise of newly developed therapeutic modalities to treat pancreatic lesions via ablation. Specifically, through the use of endoscopic ultrasound-guided therapy, endoscopists can potentially ablate these lesions safely and with minimally invasive techniques. In this manuscript we review 4 major endoscopic ultrasound-guided ablative therapies: radiofrequency ablation, ethanol injection, chemo ablation, and cryoablation. We also review the efficacy and safety of these techniques and future directions in the management of cystic pancreatic lesions.

Keywords: Endoscopic ultrasound; ethanol ablation; pancreatic neoplasm ablation; radiofrequency ablation.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Thick-walled pancreatic pseudocyst. This lesion would not be considered for endoscopic ablation
Figure 2
Figure 2
Septated mucinous cystic neoplasm of the pancreas. This lesion could be considered for endoscopic ablation
Figure 3
Figure 3
Endoscopic ultrasound fine-needle aspiration needle in a septated mucinous cystic neoplasm of the pancreas. The needle could be used to both aspirate the cyst contents and inject an ablative agent

References

    1. Yoon WJ, Brugge WR. Pancreatic cystic neoplasms:diagnosis and management. Gastroenterol Clin North Am. 2012;41:103–118.
    1. Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:824–848.e22.
    1. Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG Clinical Guideline:diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113:464–479.
    1. Moayyedi P, Weinberg DS, Schünemann H, Chak A. Management of pancreatic cysts in an evidence-based world. Gastroenterology. 2015;148:692–695.
    1. Arshad HM, Bharmal S, Duman DG, Liangpunsakul S, Turner BG. Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions. J Investig Med. 2017;65:7–14.
    1. Paik WH, Lee SH, Jang S. Future perspectives on endoscopic ultrasonography-guided therapy for pancreatic neoplasm. Clin Endosc. 2018;51:229–234.
    1. GomezGómez V, Takahashi N, Levy MJ, et al. EUS-guided ethanol lavage does not reliably ablate pancreatic cystic neoplasms (with video) Gastrointest Endosc. 2016;83:914–920.
    1. Gelczer RK, Charboneau JW, Hussain S, Brown DL. Complications of percutaneous ethanol ablation. J Ultrasound Med. 1998;17:531–533.
    1. Brugge WR. Management and outcomes of pancreatic cystic lesions. Dig Liver Dis. 2008;40:854–859.
    1. GunterGünter E, Lingenfelser T, Eitelbach F, Müller H, Ell C. EUS-guided ethanol injection for treatment of a GI stromal tumor. Gastrointest Endosc. 2003;57:113–115.
    1. Barclay RL, Perez-Miranda M, Giovannini M. EUS-guided treatment of a solid hepatic metastasis. Gastrointest Endosc. 2002;55:266–270.
    1. DeWitt J, Mohamadnejad M. EUS-guided alcohol ablation of metastatic pelvic lymph nodes after endoscopic resection of polypoid rectal cancer:the need for long-term surveillance. Gastrointest Endosc. 2011;74:446–447.
    1. DeWitt J. Endoscopic ultrasound-guided pancreatic cyst ablation. Gastrointest Endosc Clin N Am. 2012;22:291–302.
    1. Gan SI, Thompson CC, Lauwers GY, Bounds BC, Brugge WR. Ethanol lavage of pancreatic cystic lesions:initial pilot study. Gastrointest Endosc. 2005;61:746–752.
    1. DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts:a randomized, double-blind study. Gastrointest Endosc. 2009;70:710–723.
    1. Park JK, Song BJ, Ryu JK, et al. Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation. Pancreas. 2016;45:889–894.
    1. DiMaio CJ, DeWitt JM, Brugge WR. Ablation of pancreatic cystic lesions:the use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas. 2011;40:664–668.
    1. Choi JH, Lee SH, Choi YH, et al. Clinical outcomes of endoscopic ultrasound-guided ethanol ablation for pancreatic cystic lesions compared with the natural course:a propensity score matching analysis. Therap Adv Gastroenterol. 2018;11:1756284818759929.
    1. Moyer MT, Dye CE, Sharzehi S, et al. Is alcohol required for effective pancreatic cyst ablation?The prospective randomized CHARM trial pilot study. Endosc Int Open. 2016;4:E603–E607.
    1. Paiella S, Salvia R, Ramera M, et al. Local ablative strategies for ductal pancreatic cancer (radiofrequency ablation, irreversible electroporation):a review. Gastroenterol Res Pract. 2016;2016:4508376.
    1. Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014;371:836–845.
    1. European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines:management of hepatocellular carcinoma. J Hepatol. 2012;56:908–943.
    1. LaquiereLaquière A, Boustière C, Leblanc S, Penaranda G, Désilets E, Prat F. Safety and feasibility of endoscopic biliary radiofrequency ablation treatment of extrahepatic cholangiocarcinoma. Surg Endosc. 2016;30:1242–1248.
    1. Lakhtakia S, Seo DW. Endoscopic ultrasonography-guided tumor ablation. Dig Endosc. 2017;29:486–494.
    1. Haen SP, Pereira PL, Salih HR, Rammensee HG, Gouttefangeas C. More than just tumor destruction:immunomodulation by thermal ablation of cancer. Clin Dev Immunol. 2011;2011:160250.
    1. Gaidhane M, Smith I, Ellen K, et al. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract. 2012;2012:431–451.
    1. Silviu UB, Daniel P, Claudiu M, et al. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas:An experimental study with pathological correlation. Endosc Ultrasound. 2015;4:330–335.
    1. Wang D, Jin Z, Lei W, Leung JW, Li Z. Endoscopic ultrasound guided radiofrequency ablation for the treatment of advanced pancreatic carcinoma. Gastrointest Endosc. 2013;77:AB414.
    1. Song TJ, Seo DW, Lakhtakia S, et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc. 2016;83:440–443.
    1. Pai M, Habib N, Senturk H, et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg. 2015;7:52–59.
    1. Spiliotis JD, Datsis AC, Michalopoulos NV, et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol. 2007;96:89–90.
    1. Matsui Y, Nakagawa A, Kamiyama Y, Yamamoto K, Kubo N, Nakase Y. Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas. 2000;20:14–20.
    1. Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT., Jr Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236:132–139.
    1. A phase II. multicentre trial of endoscopic ultrasound guided radiofrequency ablation of cystic tumours of the pancreas. [[Accessed November 21, 2018]]. Available from: .
    1. Rowinsky EK, Donehower RC. Paclitaxel (taxol) N Engl J Med. 1995;332:1004–1014.
    1. Oh HC, Seo DW, Lee TY, et al. New treatment for cystic tumors of the pancreas:EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc. 2008;67:636–642.
    1. Oh HC, Seo DW, Song TJ, et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology. 2011;140:172–179.
    1. Moyer MT, Sharzehi S, Mathew A, et al. The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol. Gastroenterology. 2017;153:1295–1303.
    1. Signoretti M, Valente R, Repici A, Delle Fave G, Capurso G, Carrara S. Endoscopy-guided ablation of pancreatic lesions:Technical possibilities and clinical outlook. World J Gastrointest Endosc. 2017;9:41–54.
    1. Hines-Peralta A, Hollander CY, Solazzo S, Horkan C, Liu ZJ, Goldberg SN. Hybrid radiofrequency and cryoablation device:preliminary results in an animal model. J Vasc Interv Radiol. 2004;15:1111–1120.
    1. Carrara S, Arcidiacono PG, Albarello L, et al. Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas:a preliminary study. Endoscopy. 2008;40:321–326.
    1. Arcidiacono PG, Carrara S, Reni M, et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc. 2012;76:1142–1151.
    1. Di Matteo F, Grasso R, Pacella CM, et al. EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe. Gastrointest Endosc. 2011;73:632–636.
    1. Karaca C, Cizginer S, Konuk Y, et al. Feasibility of EUS-guided injection of irinotecan-loaded microspheres into the swine pancreas. Gastrointest Endosc. 2011;73:603–606.
    1. Oh HC, Seo DW, Kim SC, et al. Septated cystic tumors of the pancreas:is it possible to treat them by endoscopic ultrasonography-guided intervention? Scand J Gastroenterol. 2009;44:242–247.

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