Endoscopic Ultrasound-Guided Ablation of Focal Pancreatic Lesions: The GRUPUGE Perspective

Abstract

Focal pancreatic lesions include a heterogeneous group of solid and cystic lesions, with different natures and variable clinical, imagiological, and pathological characteristics. Several endoscopic ultrasound (EUS)-guided ablative techniques have been tested during the last decade for the treatment of these pancreatic lesions, mostly consisting of the injection of ablative agents and, more recently, radiofrequency ablation. The most encouraging EUS-guided ablation outcomes are being reached in the treatment of some pancreatic cystic neoplasms and small (≤2 cm) pancreatic neuroendocrine tumours (pNETs). Data supporting a potential role of ablative therapies in the treatment of pancreatic ductal adenocarcinoma is still lacking. In this article, GRUPUGE presents an updated perspective of the potential role of EUS-guided ablation for the treatment of pancreatic cystic neoplasms and pNETs, addressing the selection criteria and technical issues of different techniques and analysing recent data on their safety and efficacy.

Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

“…The presented results should be interpreted in light of the position EUS ablation sits in the PCL management algorithm. To date, international guidelines do not yet advocate EUS-guided ablation for PCL, and so most candidates for EUS ablation are patients who decline surgical treatment, or those who are unfit for an operation [20,45]. The expansion of this indication into all patients with definite risk factors for malignancy on the basis of PCL seems unlikely, based on our pooled rates of complete resolution.…”

“…An apparent limitation of all injection-based techniques is the existence of lobulated cysts, where cyst aspiration and agent injection into all aspects of the lesion are not feasible. Specifically, the identification of more than six locules or a mural nodule has been implicated in lower success rates of chemoablation [45]. In these cases, thermal ablation using EUS-RFA could potentially represent a reasonable alternative.…”

Pancreatic neuroendocrine neoplasms — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne trzustki — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)]

“…PanNET treatment is in the domain of surgery, although in recent years we have observed the development of procedures performed under the control of EUS as a less invasive locoregional therapeutic method compared to surgical procedures [131,132].…”

“…Leczenie PanNETs jest domeną chirurgii, choć w ostatnich latach zabiegi pod kontrolą EUS rozwijają się jako mniej inwazyjna w porównaniu z zabiegami operacyjnymi lokoregionalna metoda terapeutyczna [131,132]. Skuteczność i występowanie powikłań zależą przede wszystkim od cech guza neuroendokrynne-Guidelines operacyjnego (choroba lokalna lub lokoregionalna) SSA są zalecane (rekomendowane) w postępowaniu przedoperacyjnym jako leczenie objawowe.…”

Endotherapy in Pancreatic Diseases

“…Typical indications for ablative therapy are not well defined but it can be considered for patients with branch duct IPMN and mucinous cystadenoma (2-6 cm) who are not candidates for surgery with good life expectancy or in patients refusing surgery. 91 Multi-agent chemoablation regimens containing both paclitaxel and gemcitabine have shown encouraging results with an overall complete response rate of 64% at 12 months. 92 A large prospective multicenter study analyzed outcomes of EUS-RFA in 17 patients of pancreatic cystic neoplasms (mean size 28 mm, range 9-60 mm).…”