Endoscopic Ultrasound-Guided Ablation of Focal Pancreatic Lesions: The GRUPUGE Perspective

Abstract

Focal pancreatic lesions include a heterogeneous group of solid and cystic lesions, with different natures and variable clinical, imagiological, and pathological characteristics. Several endoscopic ultrasound (EUS)-guided ablative techniques have been tested during the last decade for the treatment of these pancreatic lesions, mostly consisting of the injection of ablative agents and, more recently, radiofrequency ablation. The most encouraging EUS-guided ablation outcomes are being reached in the treatment of some pancreatic cystic neoplasms and small (≤2 cm) pancreatic neuroendocrine tumours (pNETs). Data supporting a potential role of ablative therapies in the treatment of pancreatic ductal adenocarcinoma is still lacking. In this article, GRUPUGE presents an updated perspective of the potential role of EUS-guided ablation for the treatment of pancreatic cystic neoplasms and pNETs, addressing the selection criteria and technical issues of different techniques and analysing recent data on their safety and efficacy.

Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

“…An apparent limitation of all injection-based techniques is the existence of lobulated cysts, where cyst aspiration and agent injection into all aspects of the lesion are not feasible. Specifically, the identification of more than six locules or a mural nodule has been implicated in lower success rates of chemoablation [45]. In these cases, thermal ablation using EUS-RFA could potentially represent a reasonable alternative.…”

Therapeutic Endoscopic Ultrasound: Current Indications and Future Perspectives

“…Ablation is indicated for a presumed mucinous cystadenoma or intraductal papillary mucinous neoplasms (IPMNs) that are unilocular or oligolocular, as well as cyst >3 cm or enlarging cyst with a diameter >2 cm [90]. Typically cyst measuring 2–6 cm with fewer than 6 locules respond best to ablation [90, 91]. The cyst is accessed through a transgastric or transduodenal approach where a 22 gauge or 19-gauge fine needle aspiration is used to evacuate the cyst cavity before lavage with the ablative agent takes place [89].…”

Pancreatic neuroendocrine neoplasms — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne trzustki — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)]

“…PanNET treatment is in the domain of surgery, although in recent years we have observed the development of procedures performed under the control of EUS as a less invasive locoregional therapeutic method compared to surgical procedures [131,132].…”

“…Leczenie PanNETs jest domeną chirurgii, choć w ostatnich latach zabiegi pod kontrolą EUS rozwijają się jako mniej inwazyjna w porównaniu z zabiegami operacyjnymi lokoregionalna metoda terapeutyczna [131,132]. Skuteczność i występowanie powikłań zależą przede wszystkim od cech guza neuroendokrynne-Guidelines operacyjnego (choroba lokalna lub lokoregionalna) SSA są zalecane (rekomendowane) w postępowaniu przedoperacyjnym jako leczenie objawowe.…”