Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel

Abstract

ClinicalTrials.gov (NCT01643460).

Management of branch-duct intraductal papillary mucinous neoplasms: a large single-center study to assess predictors of malignancy and long-term outcomes

“…When patients were deemed poor surgical candidates, pancreatic cyst epithelial ablation with ethanol with or without paclitaxel injection was performed based on treating physician and patient's preferences as previously described. 17 For asymptomatic patients, imaging surveillance with EUS and CT/MRI was considered every 3-12 months as appropriate based on risks for malignancy. Since 2008, patients were rigorously followed within the Indiana University multidisciplinary pancreatic cyst program.…”

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“…In a study of 22 patients with suspected benign pancreatic cysts, treatment with EUS-guided pancreatic cyst ablation with ethanol and paclitaxel was performed, followed at 3 months by repeat EUS-FNA for DNA analysis and possible repeat treatment. Complete and partial response was observed in 50 % of patients (3 -4 months) and 25 % of patients (12 months after the second EUS-guided intervention) [326]. Post-ablation fluid analysis showed elimination of all baseline mutations in 8/19 patients, new mutations in 3 patients, and unchanged mutational status in 8 patients [326].…”

“…Complete and partial response was observed in 50 % of patients (3 -4 months) and 25 % of patients (12 months after the second EUS-guided intervention) [326]. Post-ablation fluid analysis showed elimination of all baseline mutations in 8/19 patients, new mutations in 3 patients, and unchanged mutational status in 8 patients [326]. The plasma paclitaxel concentration after EUS-guided pancreatic cyst ablation was shown to be nearly undetectable and rarely caused systemic side-effects [327].…”

Recent developments in endoscopic ultrasound-guided diagnosis and therapy of pancreatic cystic neoplasms

“…Whether cyst ablation induced changes in the DNA of cyst fluid was studied by DeWitt et al 47 in which 22 patients underwent pre-ablation DNA analysis for K ras mutation and LOH and half of them, or 11 patients had DNA mutations. Of these, patients of 72% (or 8 patients) had elimination of all baseline mutations at a median 27 month follow-up.…”