Echoendoscopic ablative therapy for solid pancreatic tumors

Abstract

Initially, endoscopic ultrasound (EUS) was developed to inspect the pancreas and other organs adjacent to the gastrointestinal tract. After introduction of curvilinear-array echoendoscopes, EUS has been used for a variety of interventions in gastroenterology, including fine needle aspiration, pancreatobiliary drainage and tumor ablation. EUS-guided ablation of pancreatic cystic tumors with ethanol and with or without cytotoxic agents has been studied, showing its potential to become an alternative to surgery. However, only few attempts at using ethanol ablation to treat solid pancreatic tumors have been reported. Recently, EUS-guided radiofrequency ablation was introduced and has been cautiously applied for pancreatic cancer. This article focuses on the clinical application of EUS for the ablation of solid pancreatic tumors.

Ultrasound–Guided Percutaneous Laser Ablation: A New Treatment Option for Pancreatic Cancer

“…PC therapy is an arduous challenge for thermal ablation from anatomical consideration. Only limited studies have reported the application of ablation in experimental and clinical setting in the management of solid and cystic PC, including radiofrequency, microwave, ethanol ablation, high-intensity focused US, cryoablation and irreversible electroporation technique [5,6,9,[23][24][25][26]. Among them, radiofrequency, cryoablation and ethanol ablation were most commonly used methods for unresectable PC [27].…”

Future Perspectives on Endoscopic Ultrasonography-Guided Therapy for Pancreatic Neoplasm

“…Regarding pancreatic solid neoplasms, small functioning pancreatic neuroendocrine tumors (PNETs) of <2 cm are the most appropriate indication for EUS-guided ablation therapy. Functioning PNETs have hormone-related symptoms and malignant potential [ 19 ]. As functioning NETs are usually small and sometimes manifest as multiple lesions [ 27 ], EUS-guided ablation therapy can be considered as a complementary tool to surgical resection.…”

“…As functioning NETs are usually small and sometimes manifest as multiple lesions [ 27 ], EUS-guided ablation therapy can be considered as a complementary tool to surgical resection. Evaluation of treatment response after ablation therapy of functioning PNETs can be performed by assessing the improvement of hormone-related symptom and/or with serial hormonal assays [ 15 , 16 , 19 ]. EUS-guided ablation therapy for small nonfunctioning PNETs and solid pseudopapillary neoplasms is also under investigation.…”

“…Given the substantial heterogeneity of the reported efficacy of EUS-guided ablation therapy, each step of the procedure should be evaluated to optimize efficacy. Furthermore, the procedure-related safety issues, including the occurrence of pancreatitis, vascular injury, and infection, and the risks of tumor seeding, recurrence or metastasis need to be studied further [ 19 ]. The clinical issues and future perspectives of EUS-guided ablation therapy will be discussed.…”

Endoscopic Ultrasound – guided perivascular pancreatic Radiofrequency Ablation using a Hydroxyethyl Starch Solution prior to Pancreatectomy

“…Following different survival periods (0-4 days) in the interventional group (n=3), open pancreatectomy was carried out. The control group (n=4) included open pancreatectomies in two pigs with non-treated pancreases and in two with pancreatic RFA on the same day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 .…”