An update on EUS-guided ablative techniques for pancreatic cystic lesions

Abstract

Pancreatic cystic lesions (PCLs) are increasingly being recognized due to improvements and widespread use of cross-sectional imaging. With an estimated prevalence of 15% in general population, incidentally discovered PCLs represent a dilemma in management. While pancreatectomies offer a chance of cure, the morbidity is considerable in patients with high surgical risks. More recently, EUS-guided approaches for cyst ablation are being offered in clinical trials for the management of PCLs. EUS-chemoablation studies have progressed from first investigating safety and efficacy of EUS-guided alcohol lavage to single-agent paclitaxel ablation. Recent studies have shown that alcohol lavage may not be required, and long-term resolution can be achieved by chemoablation alone. EUS-guided lauromacrogol ablation and EUS-guided radiofrequency ablation (RFA) are new techniques that have shown promising results in a few small studies. Overall, the current literature suggests that EUS-guided paclitaxel ablation has better cyst resolution rates compared to other existing minimally invasive techniques including ethanol injection, lauromacrogol ablation, or RFA. This article will review EUS-guided PCL ablation approaches and future directions the field is headed into.

Short-Term Outcomes of Endoscopic Ultrasound-Guided Pancreatic Cyst Ablation: A Systematic Review and Meta-Analysis

“…EUS-PCA is a valuable alternative for patients who are deemed unsuitable for surgical intervention. Nevertheless, it is imperative to note that EUS ablation is not a suitable treatment for all types of cysts [10,31,32]. In 2019, an international position statement on EUS-guided PC ablation recommended chemoablation for surgically t patients with an anticipated reasonable life expectancy, con rmed diagnosis of a mucinous pancreatic cyst that is 2 cm and enlarging or at least 3 centimeters in diameter [10,32].…”

“…Nevertheless, it is imperative to note that EUS ablation is not a suitable treatment for all types of cysts [10,31,32]. In 2019, an international position statement on EUS-guided PC ablation recommended chemoablation for surgically t patients with an anticipated reasonable life expectancy, con rmed diagnosis of a mucinous pancreatic cyst that is 2 cm and enlarging or at least 3 centimeters in diameter [10,32]. Nevertheless, the group did not reach a consensus on absolute indications or contraindications for EUS-PCA.…”

Endoscopic Ultrasound-Guided Ablation of Premalignant Pancreatic Cysts and Pancreatic Cancer

“…Endoscopic ultrasound (EUS)-guided ablation offers a less invasive and lower-risk alternative to traditional surgical procedures for PCLs and PDAC [ 9 ]. There are a variety of methods used for endoscopic ablation, including ethanol, direct chemotherapy injection, radiofrequency ablation, and photodynamic therapy [ 10 ]. Despite the differences in their mechanisms, these endoscopic ablation methods share the common net effect of causing localized necrosis within the lesion while preserving the surrounding healthy pancreatic tissue [ 11 ].…”

EUS-guided interventional therapies for pancreatic diseases

“…EUS-guided ablation encompasses a wide array of procedures, such as EUS-guided ethanol ablation (EUS-EA), EUS-guided radiofrequency ablation (EUS-RFA), EUS-guided cryothermal ablation (EUS-CTA), EUS-guided photodynamic therapy (EUS-PDT), and EUS-guided laser ablation (EUS-LA). Collectively, these procedures offer a diverse range of therapeutic modalities guided by EUS ( 57 ) ( Table 2 ).…”