Endoscopic ablation therapy for the pancreatic neoplasms

Abstract

Recently, endoscopic ultrasound (EUS)‐guided ablation therapy has been reported as a less invasive therapy for patients with pancreatic neoplasms. Some ablation techniques, including injective ablation (using ethanol or other ablative agents), radiofrequency ablation (RFA), photodynamic therapy, and laser ablation, have been described in the literature. Among these, injective ablation and RFA are more frequently used for treating pancreatic neoplasms. Few studies have evaluated the effectiveness of EUS‐guided ethanol ablation (EUS‐EA) for potentially malignant solid neoplasms (neuroendocrine neoplasms or solid pseudopapillary neoplasms) and have reported a complete response (CR) rate of 60–80%. In addition, the CR rate after EUS‐RFA for these lesions has been reported to be 55–100%, with no additional procedure‐related adverse events (AEs). Regarding the amelioration of the symptoms of an insulinoma, the success rates of both the therapies were found to be excellent. Regarding complete tumor ablation, EUS‐RFA appeared to be superior to EUS‐EA. Although EUS‐RFA has been reported as a safe treatment for pancreatic cancers, its effectiveness remains inadequate. Some studies have examined the effectiveness of EUS‐guided injection ablation therapy for pancreatic cystic neoplasms (PCNs) and have reported CR rates that range from 35% to 79%. Alcohol‐free chemotherapeutic agent ablation appears to be effective, with a low risk of AEs. However, studies on the effectiveness of EUS‐RFA for PCNs are limited. In the future, EUS‐guided ablation therapy could become a more widely used approach for potentially malignant and malignant pancreatic lesions.

EUS-guided interventional therapies for pancreatic diseases

“…Garg et al ( 81 ) conducted a comparative analysis of the clinical and technical success rates, as well as AEs, associated with the two techniques for pancreatic NETs, revealing no substantial differences. However, EUS-RFA demonstrates a higher complete response (CR) rate for tumors ( 82 ). Conversely, EUS-EA exhibits a higher CR rate but has a greater frequency of AEs in cases of cystic lesions ( 73 ).…”

Local Sustained Chemotherapy of Pancreatic Cancer Using Endoscopic Ultrasound-Guided Injection of Biodegradable Thermo-Sensitive Hydrogel

“…Specifically, EUS-guided fine needle injection (EUS-FNI) has been regarded as a feasible and minimally invasive interventional option for local management of PC. 18 In 2016, a study demonstrated that EUS-guided intramural injection of GEM is feasible and potentially effective for treating locally advanced PC. 19 However, benefits were limited because of the rapid clearance of GEM and the advanced stage of cancer in patients.…”

The effect of different drugs on the ablation of subcutaneous insulinoma in nude mice

“…Preliminary studies have demonstrated that ultrasound endoscopy-guided injection ablation, as well as ultrasound or computed tomography (CT)-guided radiofrequency ablation, are safe and feasible minimally invasive treatment methods for insulinoma. These approaches have been shown to have signi cantly lower operational di culties, complications, and medical costs compared to traditional surgery [10][11][12][13][14] . Furthermore, they are less challenging, less complex, and more cost-effective than conventional surgical interventions.…”

“…Although ethanol is a traditional ablative agent, its use can be associated with complications such as pancreatitis, peritonitis, pancreatic pseudocysts, as well as hematomas and ulcers in adjacent organs [7,14] . Extensive efforts have been made to enhance the e cacy and safety of ablative therapy for insulinomas, leading to the exploration of various drugs in recent years.…”