Clin Endosc.  2015 Jul;48(4):308-311. 10.5946/ce.2015.48.4.308.

Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses

• Kim J

• KMID: 1964273
• DOI: http://doi.org/10.5946/ce.2015.48.4.308

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.

Keyword

Endosonography; Pancreatic cyst; Pancreatic neoplasms; Ablation

MeSH Terms

Catheter Ablation
Endosonography
Ethanol
Gastrointestinal Tract
Paclitaxel
Pancreatic Cyst*
Pancreatic Neoplasms
Therapeutic Irrigation
Ultrasonography
Ethanol
Paclitaxel

Figure

• 

  Fig. 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.

• 

  Fig. 2 Endoscopic ultrasound-guided radiofrequency ablation. (A) The distal part of the mass is ablated by a radiofrequency ablating needle. (B) The more proximal part of the mass is ablated. (C) According to needle withdrawal, ablation is repetitively performed in the proximal part of the mass.

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