Endoscopic ultrasonography‐guided tumor ablation

Abstract

Real-time guidance of needle advancement has transformed endoscopic ultrasound (EUS) from a diagnostic to an interventional procedure. EUS-guided fine-needle puncture has application in various interventional procedures (drainage of pseudocyst, biliary intervention, and injection of drugs). Celiac plexus or ganglion neurolysis for pain control is the major current EUS-guided fine-needle injection procedure. Feasibility and safety to accurately position needle devices and/or inject under real-time EUS imaging with precise delivery of interventional agent have expanded the use of EUS to ablate tumors. These include radiofrequency ablation, or delivery of fiducial markers, potential antitumor agents, or radioactive seeds, in the cancer mass. Minimally invasive EUS-guided antitumor therapy is primarily used for pancreatic cancer because of better anatomic access (vs other imaging modality) and the dismal prognosis (despite improvements in surgery and chemoradiation). Also, the response to parenteral chemotherapy in pancreatic cancer is poor because of suboptimal drug delivery resulting from hypovascularity and abundant desmoplasia. Other targets for EUS-guided tumor ablation are pancreatic neuroendocrine tumor and pancreatic cyst lesion, which are less aggressive and curable by resection. However, patients non-eligible for surgery may benefit from local EUSguided ablation.

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

“…Moreover, using percutaneous or EUS guidance, a safe mini-invasive approach can be obtained avoiding laparotomy. To the best of our knowledge, 10 patients underwent pancreatic EUS-RFA with the EUSRA electrode without severe adverse events and with high technical success [5,[18][19][20]. The results of our series confirm the feasibility, safety and local thermal effect of the procedure.…”

Report of the International Symposiums at the 95th Congress of Japan Gastroenterological Endoscopy Society in Tokyo, 2018

“…PDT might have potential systemic immunomodulatory effects and prolong survival in addition to local effects. EUS‐guided ablation of pancreatic tumors was discussed by Kongkam. Although it appears safe and effective, the indication should be further established as it is basically local tumor ablation.…”

Efficacy and safety of scheduled early endoscopic ultrasonography‐guided ethanol reinjection for patients with pancreatic neuroendocrine tumors: Prospective pilot study

“…The optimal approach for treating patients with nonfunctional, small (≤2 cm in diameter) pancreatic neuroendocrine tumors (p‐NET) is controversial . Recently, endoscopic ultrasonography (EUS)‐guided ablation has been proposed for the treatment of patients with small p‐NET . Using a pure ethanol or ethanol‐lipiodol emulsion, the complete ablation rate has been reported to be approximately 50% with a single session and up to 60% with an additional session .…”

“…1,2 Recently, endoscopic ultrasonography (EUS)-guided ablation has been proposed for the treatment of patients with small p-NET. [3][4][5][6][7][8] Using a pure ethanol or ethanol-lipiodol emulsion, the complete ablation rate has been reported to be approximately 50% with a single session and up to 60% with an additional session. 3,4 Mild pancreatitis occurred in a few patients who required injection with a large amount of ethanol in one session.…”