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Future Perspectives on Endoscopic Ultrasonography-Guided Therapy for Pancreatic Neoplasm

  • Paik, Woo Hyun (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Sang Hyub (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jang, Sunguk (Department of Gastroenterology and Hepatology, Cleveland Clinic)
  • Received : 2018.04.09
  • Accepted : 2018.04.27
  • Published : 2018.05.30

Abstract

Endoscopic ultrasonography (EUS)-guided therapy with ethanol injection or catheter-based radiofrequency ablation for pancreatic neoplasm has been conducted as a potential alternate treatment modality for patients who are not eligible for surgery. On the basis of the limited number of studies available, EUS-guided ablation therapy with the aforementioned methods for small pancreatic neoplasms has demonstrated promising technical feasibility and safety profiles. To be considered as a legitimate alternative option to surgery, however, EUS-guided ablation therapy must provide a long-term efficacy profile along with the consensus among experts regarding its treatment parameter. This review focuses on the clinical issues and future perspectives of EUS-guided therapy for pancreatic neoplasm.

Keywords

References

  1. de Jong K, Nio CY, Hermans JJ, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010;8:806-811. https://doi.org/10.1016/j.cgh.2010.05.017
  2. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802-807. https://doi.org/10.2214/AJR.07.3340
  3. Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017;3:1335-1342. https://doi.org/10.1001/jamaoncol.2017.0589
  4. Haynes AB, Deshpande V, Ingkakul T, et al. Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg 2011;146:534-538. https://doi.org/10.1001/archsurg.2011.102
  5. Han J, Chang KJ. Endoscopic ultrasound-guided direct intervention for solid pancreatic tumors. Clin Endosc 2017;50:126-137. https://doi.org/10.5946/ce.2017.034
  6. Lee SH. [Endoscopic treatment for pancreatic cystic lesions]. Korean J Gastroenterol 2018;71:10-17. https://doi.org/10.4166/kjg.2018.71.1.10
  7. 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.
  8. Lee LS, Andersen DK, Ashida R, et al. EUS and related technologies for the diagnosis and treatment of pancreatic disease: research gaps and opportunities-summary of a national institute of diabetes and digestive and kidney diseases workshop. Gastrointest Endosc 2017;86:768-778. https://doi.org/10.1016/j.gie.2017.08.006
  9. Gomez 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. https://doi.org/10.1016/j.gie.2015.08.069
  10. 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. https://doi.org/10.1053/j.gastro.2010.10.001
  11. 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. https://doi.org/10.1016/j.gie.2007.09.038
  12. Park JK, Song BJ, Ryu JK, et al. Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation. Pancreas 2016;45:889-894. https://doi.org/10.1097/MPA.0000000000000567
  13. Choi JH, Seo DW, Song TJ, et al. Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts. Endoscopy 2017;49:866-873. https://doi.org/10.1055/s-0043-110030
  14. DeWitt JM, Al-Haddad M, Sherman S, et al. Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel. Endoscopy 2014;46:457-464. https://doi.org/10.1055/s-0034-1365496
  15. Levy MJ, Thompson GB, Topazian MD, Callstrom MR, Grant CS, Vella A. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc 2012;75:200-206. https://doi.org/10.1016/j.gie.2011.09.019
  16. Park DH, Choi JH, Oh D, et al. Endoscopic ultrasonography-guided ethanol ablation for small pancreatic neuroendocrine tumors: results of a pilot study. Clin Endosc 2015;48:158-164. https://doi.org/10.5946/ce.2015.48.2.158
  17. Yang D, Inabnet WB 3rd, Sarpel U, DiMaio CJ. EUS-guided ethanol ablation of symptomatic pancreatic insulinomas. Gastrointest Endosc 2015;82:1127. https://doi.org/10.1016/j.gie.2015.06.030
  18. Paik WH, Seo DW, Dhir V, Wang HP. Safety and efficacy of EUS-guided ethanol ablation for treating small solid pancreatic neoplasm. Medicine (Baltimore) 2016;95:e2538. https://doi.org/10.1097/MD.0000000000002538
  19. Paik WH, Seo DW. Echoendoscopic ablative therapy for solid pancreatic tumors. J Dig Dis 2017;18:135-142. https://doi.org/10.1111/1751-2980.12453
  20. Cho MK, Choi JH, Seo DW. Endoscopic ultrasound-guided ablation therapy for pancreatic cysts. Endosc Ultrasound 2015;4:293-298. https://doi.org/10.4103/2303-9027.170414
  21. Lee LS, Wu BU, Banks PA, et al. Utility of commercial DNA analysis in detecting malignancy within pancreatic cysts. JOP 2013;15:182-188.
  22. Correa-Gallego C, Ferrone CR, Thayer SP, Wargo JA, Warshaw AL, Fernandez-Del Castillo C. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 2010;10:144-150. https://doi.org/10.1159/000243733
  23. Chiang AL, Lee LS. Clinical approach to incidental pancreatic cysts. World J Gastroenterol 2016;22:1236-1245. https://doi.org/10.3748/wjg.v22.i3.1236
  24. Jang DK, Song BJ, Ryu JK, et al. Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas 2015;44:1329-1333. https://doi.org/10.1097/MPA.0000000000000396
  25. Del Chiaro M, Segersvard R, Pozzi Mucelli R, et al. Comparison of preoperative conference-based diagnosis with histology of cystic tumors of the pancreas. Ann Surg Oncol 2014;21:1539-1544. https://doi.org/10.1245/s10434-013-3465-9
  26. Park JS, Seo DW, Song TJ, et al. Endoscopic ultrasound-guided ablation of branch-duct intraductal papillary mucinous neoplasms: feasibility and safety tests using porcine gallbladders. Dig Endosc 2016;28:599-606. https://doi.org/10.1111/den.12628
  27. Kim MK. Endoscopic ultrasound in gastroenteropancreatic neuroendocrine tumors. Gut Liver 2012;6:405-410. https://doi.org/10.5009/gnl.2012.6.4.405
  28. Nanno Y, Matsumoto I, Zen Y, et al. Pancreatic duct involvement in well-differentiated neuroendocrine tumors is an independent poor prognostic factor. Ann Surg Oncol 2017;24:1127-1133. https://doi.org/10.1245/s10434-016-5663-8
  29. Canellas R, Burk KS, Parakh A, Sahani DV. Prediction of pancreatic neuroendocrine tumor grade based on CT features and texture analysis. AJR Am J Roentgenol 2018;210:341-346. https://doi.org/10.2214/AJR.17.18417
  30. 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. https://doi.org/10.1016/S0016-5107(05)00320-2
  31. Matthes K, Mino-Kenudson M, Sahani DV, Holalkere N, Brugge WR. Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection. Gastrointest Endosc 2007;65:272-277. https://doi.org/10.1016/j.gie.2006.04.043
  32. Caillol F, Poincloux L, Bories E, et al. Ethanol lavage of 14 mucinous cysts of the pancreas: a retrospective study in two tertiary centers. Endosc Ultrasound 2012;1:48-52.
  33. 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. https://doi.org/10.1097/MPA.0b013e3182128d06
  34. 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. https://doi.org/10.1016/j.gie.2009.03.1173
  35. Vazquez-Sequeiros E, Maluf-Filho F. Endosonography-guided ablation of pancreatic cystic tumors: is it justified? Gastrointest Endosc 2016;83:921-923. https://doi.org/10.1016/j.gie.2015.10.032
  36. Armellini E, Crino SF, Ballare M, Occhipinti P. Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor. Endoscopy 2015;47 Suppl 1 UCTN:E600-E601. https://doi.org/10.1055/s-0034-1393677
  37. 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. https://doi.org/10.4240/wjgs.v7.i4.52
  38. Lakhtakia S, Ramchandani M, Galasso D, et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 2016;83:234-239. https://doi.org/10.1016/j.gie.2015.08.085
  39. 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. https://doi.org/10.1053/j.gastro.2017.08.009
  40. Lakhtakia S, Seo DW. Endoscopic ultrasonography-guided tumor ablation. Dig Endosc 2017;29:486-494. https://doi.org/10.1111/den.12833
  41. Oh HC, Seo DW, Kim SC. Portal vein thrombosis after EUS-guided pancreatic cyst ablation. Dig Dis Sci 2012;57:1965-1967. https://doi.org/10.1007/s10620-012-2103-x
  42. 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. https://doi.org/10.4103/2303-9027.170426
  43. Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P, Bassi C. Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 2010;97:220-225. https://doi.org/10.1002/bjs.6800
  44. Nakai Y, Iwashita T, Park DH, Samarasena JB, Lee JG, Chang KJ. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204-1214. https://doi.org/10.1016/j.gie.2014.10.025
  45. Attili F, Pagliari D, Rimbas M, et al. Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps. Endoscopy 2016;48 Suppl 1:E188-E189. https://doi.org/10.1055/s-0042-108194
  46. Karia K, Waxman I, Konda VJ, et al. Needle-based confocal endomicroscopy for pancreatic cysts: the current agreement in interpretation. Gastrointest Endosc 2016;83:924-927. https://doi.org/10.1016/j.gie.2015.08.080

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  1. Endoscopic ultrasound-guided ablation of pancreatic cystic neoplasms: ready for prime time? vol.32, pp.1, 2018, https://doi.org/10.20524/aog.2018.0331