Clin Endosc.  2015 Mar;48(2):158-164. 10.5946/ce.2015.48.2.158.

Endoscopic Ultrasonography-Guided Ethanol Ablation for Small Pancreatic Neuroendocrine Tumors: Results of a Pilot Study

• Park DH
• Choi JH
• Oh D
• Lee SS
• Seo DW
• Lee SK
• Kim MH

• KMID: 1801208
• DOI: http://doi.org/10.5946/ce.2015.48.2.158

Abstract

BACKGROUND/AIMS
Endoscopic ultrasonography (EUS)-guided ethanol ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of this study was to evaluate the safety, feasibility, and treatment response after EUS-guided ethanol injection for small pancreatic neuroendocrine tumors (p-NETs).
METHODS
This was a retrospective analysis of a prospectively collected database including 11 consecutive patients with p-NETs who underwent EUS-guided ethanol injection.
RESULTS
EUS-guided ethanol injection was successfully performed in 11 patients with 14 tumors. The final diagnosis was based on histology and clinical signs as follows: 10 non-functioning neuroendocrine tumors and four insulinomas. During follow-up (median, 370 days; range, 152 to 730 days), 10 patients underwent clinical follow-up after treatment, and one patient was excluded because of loss to follow-up. A single treatment session with an injection of 0.5 to 3.8 mL of ethanol resulted in complete responses (CRs) at the 3-month radiologic imaging for seven of 13 tumors (response rate, 53.8%). Multiple treatment sessions performed in three tumors with residual viable enhancing tissue increased the number of tumors with CRs to eight of 13 (response rate, 61.5%). Mild pancreatitis occurred in three of 11 patients.
CONCLUSIONS
EUS-guided ethanol injection appears to be a safe, feasible, and potentially effective method for treating small p-NETs in patients who are poor surgical candidates.

Keyword

Endosonography; Ethanol; Ablation; Neuroendocrine tumors

MeSH Terms

Diagnosis
Endosonography
Ethanol*
Follow-Up Studies
Humans
Insulinoma
Neuroendocrine Tumors*
Pancreatitis
Pilot Projects*
Prospective Studies
Retrospective Studies
Ethanol

Figure

• 

  Fig. 1 (A) Contrast-enhanced computed tomography (CT) scan showing a hypervascular mass in the pancreatic head. (B) Sonographic volumetric analysis of the tumor using 3-dimensional software. (C) Endoscopic ultrasonography-guided puncture of a neuroendocrine tumor. (D) Use of a 22-gauge needle for multiple injections of 99% ethanol until the hyperechoic blush extended to the margin of the tumor. (E) Eight-month follow-up CT scan showing successful ethanol ablation of a tumor.

• 

  Fig. 2 Study flowchart. CT, computed tomography; CE-EUS, contrast-enhanced endoscopic ultrasonography; NET, neuroendocrine tumor; EUS-FNA, endoscopic ultrasonography-guided fine-needle aspiration; 3D, 3-dimensional; CECT, contrast-enhanced computed tomography.

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