Safety and Efficacy of EUS-Guided Ethanol Ablation for Treating Small Solid Pancreatic Neoplasm

Paik, Woo Hyun; Seo, Dong Wan; Dhir, Vinay; Wang, Hsiu–Po

doi:10.1097/md.0000000000002538

Cited by 56 publications

(72 citation statements)

References 15 publications

(21 reference statements)

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“…The volume of alcohol injected to the small tumours (as those described) should not exceed 3.0 ml. This conclusion is supported by another severe complication of ablation (of non-functioning neuroendocrine tumour) reported by Paik et al [28]. The injection of 5.0 ml of alcohol with use of a multi-hole celiac plexus neurolysis needle (CPN) resulted in acute pancreatitis and 36 days of hospital stay [28].…”

Section: Opis Przypadkusupporting

confidence: 66%

“…This conclusion is supported by another severe complication of ablation (of non-functioning neuroendocrine tumour) reported by Paik et al [28]. The injection of 5.0 ml of alcohol with use of a multi-hole celiac plexus neurolysis needle (CPN) resulted in acute pancreatitis and 36 days of hospital stay [28]. Therefore, the authors recommend use of a single-hole needle in the procedure [28].…”

Section: Opis Przypadkusupporting

confidence: 61%

“…In non-functioning tumours the issue of follow-up is more complex. Some authors performed follow-up EUS (also in insulinoma) and it revealed partial or total tumour size regression [17,19,28]. However, we are not able to predict long-term results and the risk of development of metastases and recurrence of the disease [22,28,31,32].…”

Section: Opis Przypadkumentioning

confidence: 94%

“…The Medline database research shows 14 cases or case series of insulinoma EUS-guided ethanol ablation [17][18][19][20][21][22][23][24][25][26][27]. Moreover, there are also reports of alcoholic ablation of other pancreatic tumours of neuroendocrine and other origin (especially cystic pancreatic tumours) [28][29][30]. Some prospective studies are still in progress [29].…”

Section: Opis Przypadkumentioning

confidence: 99%

“…The side effects were generally mild and self-limiting: mild acute pancreatitis, fever, abdominal pain [17,18,22,28]. Only one described event should be classified as severe-bleeding from duodenal ulcer (Forrest 2a) with haematoma, which was treated conservatively with proton pump inhibitor [19].…”

Section: Opis Przypadkumentioning

confidence: 99%

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Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review

Dąbkowski

Gajewska

et al. 2017

Endokrynologia Polska

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Introduction: EUS-guided ethanol ablation of insulinoma is a new method of treatment of this neuroendocrine tumour. Ablation is recommended in patients who are poor surgical candidates or refuse surgery. We present a case of an 81-year-old female with symptomatic insulinoma, treated successfully with EUS-guided alcoholic ablation, along with a literature review including 28 other previously described cases. The effectiveness, safety of the therapy, and technical procedure-related issues are summarised. To the best of our knowledge, this is the first described case of successful insulinoma EUS-guided ablation in Poland. Material and methods:We searched the PubMed/Medline database to identify cases of EUS-guided alcoholic ablation. Our analysis included 14 articles (case reports or case series), with a total of 27 patients and 31 tumours described, published before February 2017. Results: The described tumours were relatively small (mean 13 mm), and the most common location was pancreatic head. The mean ethanol volume injected to the tumour was 1.8 ml and the concentration of infused alcohol varied from 95% to 98%.Side effects were observed in six cases; apart from one, they were mild and self-limiting. There was only one severe adverse event, treated conservatively with success. The median follow-up was 14.4 months (2-55 months). In all described cases ablation led to improvement of the symptoms and normalisation of glycaemia. Conclusions:The EUS-guided alcoholic ablation of insulinoma is a safe and effective method of treatment in patients who are poor surgical candidates and/or refuse surgery. The adverse effects are rare and mild and were observed when the volume of injected ethanol was equal to or above 3.0 ml. However, the data is limited, the follow-up is relatively short, and prospective studies are needed to confirm the long-term effects of treatment. The study shows also that there are important procedural differences (concentration and volume of alcohol, needle gauge, number of sessions) between the endoscopists, which should be specified. (Endokrynol Pol 2017; 68 (4): 472-479)

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Section: Opis Przypadkusupporting

confidence: 66%

Section: Opis Przypadkusupporting

confidence: 61%

Section: Opis Przypadkumentioning

confidence: 94%

Section: Opis Przypadkumentioning

confidence: 99%

Section: Opis Przypadkumentioning

confidence: 99%

See 3 more Smart Citations

Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review

Dąbkowski

Gajewska

et al. 2017

Endokrynologia Polska

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Endoscopic ultrasonography‐guided ethanol ablation of pancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 disease following complicated total pancreatectomy

Lin

Chang

Chen

2019

Adv in Digestive Medicine

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Although pancreatic neuroendocrine tumors (pNETs) account for a small proportion of all pancreatic tumors (1.3%), their incidence is increasing. A 54‐year‐old woman was previously diagnosed with hyperparathyroidism and prolactinoma. A magnetic resonance imaging (MRI) scan showed several oval homogeneous enhancement nodules on the pancreas, with sizes up to 10 mm, and endoscopic ultrasonography (EUS)‐guided fine needle aspiration cytology (FNAC) confirmed the diagnosis of pNETs. Based on her history of primary hyperparathyroidism combined with prolactinoma and her family history of multiple endocrine neoplasia type 1 (MEN1)‐associated tumors, a diagnosis of MEN1 was made. Two months after the surgery, a follow‐up abdominal computed tomography (CT) scan showed a pancreatic remnant that was 15 mm in length, and at the 5‐month follow up, a 6 × 5 mm residual pNET within the pancreatic remnant was detected by EUS, CT, and MRI. Because the patient adamantly refused repeat surgical resection, we decided to ablate the lesion via an EUS‐guided ethanol injection with 1.3 mL and 1.0 mL of 99.5% alcohol in two sessions. At the 4‐month follow up, the contrast‐enhanced MRI showed no residual pNET. Repeated EUS with concurrent FNAC also yielded negative results. We concluded that we achieved a good response after the EUS‐guide ablation. EUS‐guided ethanol ablation is a feasible, safe, and efficient method of treatment when applied for small pNETs in MEN1 disease following complicated total pancreatectomy. However, the long‐term outcomes must be confirmed in future multicenter prospective studies comparing surgical resection and minimally invasive EUS ablation.

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Retroperitoneal and Abdominal Lesions Laser Ablation

Mauri

Zhao

Chai

2019

Image-Guided Laser Ablation

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Safety and Efficacy of EUS-Guided Ethanol Ablation for Treating Small Solid Pancreatic Neoplasm

Abstract: Supplemental Digital Content is available in the text

Cited by 56 publications

References 15 publications

Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review

Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review

Endoscopic ultrasonography‐guided ethanol ablation of pancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 disease following complicated total pancreatectomy

Retroperitoneal and Abdominal Lesions Laser Ablation

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