Ethanol lavage of pancreatic cystic lesions: initial pilot study

Gan, S. Ian; Thompson, Christopher C.; Lauwers, Gregory Y.; Bounds, Brenna C.; Brugge, William R.

doi:10.1016/s0016-5107(05)00320-2

Cited by 266 publications

(183 citation statements)

References 22 publications

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“…To date, there have been five studies using either ethanol alone or with paclitaxel for cyst ablation. [34][35][36][37][38] Cyst have decreased to <5 % of their original size following ablation in 33 to 35 % of patients treated with ethanol 34,37 and 50 to 79 % using combination alcohol and paclitaxel, 35,36,38 with increased ablation when more than one ablation session is performed. 39 In patients who have undergone surgical resection, cyst epithelial ablation varies from 0 to 100 %.…”

Section: Cystic Neuroendocrine Neoplasmsmentioning

confidence: 99%

“…Complications from this procedure are higher than those reported with routine EUS-FNA of a pancreatic cyst, with postprocedure pancreatitis occurring in between 2 and 10 % of patients, abdominal pain in 2 % to 20 %, fever in 2 %, and intracystic bleeding in 2 %. [34][35][36][37][38] Cyst ablation is an interesting concept, but given the lack of complete ablation of the epithelium, it should only be performed in individuals who are not surgical candidates and should be performed as part of a clinical trial.…”

Section: Cystic Neuroendocrine Neoplasmsmentioning

confidence: 99%

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Cystic Neoplasms of the Pancreas

Lennon

Wolfgang

2013

Journal of Gastrointestinal Surgery

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Pancreatic cysts are being identified with increasing frequency due to a combination of increased awareness and more frequent use of cross sectional imaging. Cystic neoplasms of the pancreas range from completely benign to frankly malignant. Identifying pre-malignant cysts offers the opportunity to prevent the development of pancreatic cancer. This article reviews the presentation, workup, and non-operative and operative management of premalignant and malignant pancreatic cysts.

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Section: Cystic Neuroendocrine Neoplasmsmentioning

confidence: 99%

Section: Cystic Neuroendocrine Neoplasmsmentioning

confidence: 99%

Cystic Neoplasms of the Pancreas

Lennon

Wolfgang

2013

Journal of Gastrointestinal Surgery

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“…[14][15][16]20 Although both MCNs and IPMNs are known to have malignant potential, and therefore have historically all been resected, recent studies highlighting slow growth and indolence of many of these neoplastic mucinous cysts 15,17 have led to increased use of nonsurgical alternatives, from close clinical follow-up to in situ ablation. 13,20,[28][29][30][31][32][33] Main duct IPMNs, regardless of symptoms, cytology, or the presence of a mural nodule, are considered high risk for malignancy, and are therefore all resected in surgically fit candidates. 8,34 For patients with suspected branch duct IPMNs or MCNs, recent international consensus guidelines recommend surgical resection for patients with mucinous cysts either >3 cm or smaller cysts with high-risk features such as symptoms, positive cytology, or a mural nodule.…”

Section: Clinical Managementmentioning

confidence: 99%

Pancreatic cysts

Pitman

Lewandrowski

Shen

et al. 2010

Cancer Cytopathology

125

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Preoperative diagnosis of pancreatic cysts benefits from integrating the clinical, radiological, and cytological features. As patient management algorithms evolve to increasingly nonsurgical options, accuracy in distinguishing mucinous from nonmucinous and benign from malignant mucinous cysts is important. This review focuses on pseudocysts, serous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms. Patients with pseudocysts almost always present with pancreatitis and are usually medically managed. Radiological studies reveal a unilocular cyst mostly in the pancreatic tail. Cyst fluid is thin, with high amylase but low carcinoembryonic antigen (CEA) levels. DNA mutations are absent. Serous cystadenomas are benign and do not require resection. Patients are usually asymptomatic and have microcystic or macrocystic masses anywhere in the pancreas. Cytology is frequently nondiagnostic. CEA and amylase levels are low. DNA analysis may reveal loss of heterozygosity (LOH) at 3p if associated with Von Hippel-Lindau disease. Neoplastic mucinous cysts are highly variable in their presentation. Most are resected. Mucinous cystic neoplasms typically arise in the body or tail of the pancreas of middle-aged women and demonstrate a septated cyst without dilatation of the main pancreatic duct. Branch duct IPMNs are more common in the pancreatic head of elderly men. Main duct dilatation correlates with main duct or combined type IPMN. Both types of mucinous cysts produce variable amounts of mucin. Cytologically nonmalignant but atypical epithelial cells, even when scant, are an indication of a high risk for malignancy. High CEA level supports a mucinous cyst, as do KRAS mutation and good quality DNA levels. KRAS mutation and multiple LOH support malignancy.

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“…Attempts have been made at ablating the epithelial lining of cystic tumours of the pancreas with ethanol lavage via EUS‐FNI but with limited success 69 . A preliminary study found that the combination of ethanol lavage and paclitaxel injection was safe and effective 70 .…”

Section: Eus‐guided Injection Therapymentioning

confidence: 99%