Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer

Onsite evaluation of endoscopic ultrasound fine needle aspiration: the endosonographer, the cytotechnologist and the cytopathologist

“…As EUS evolves, intraprocedural techniques, which could be performed immediately following a definitive, in-room diagnosis of malignancy, could be expanded to include not only early celiac plexus neurolysis, but possibly fiducial marker placement, injection of anti-tumoral chemotherapeutic agents, or ablative therapy (e.g., by ethanol injection, radiofrequency, photodynamic therapy, laser, cryotherapy, brachytherapy, etc. [22][23][24][25][26][27]), and also, THE ENDOSONOGRAPHER, THE CYTOTECHNOLOGIST AND THE CYTOPATHOLOGIST Rev esp enfeRm Dig 2017;109(4):279-283 the placement of stents (metal versus plastic) and immediate surgical evaluation. Further work is needed to determine for which clinical situations and applications ROSE is beneficial.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…No pancreatitis was noted in the successful group, although an increase in amylases was seen in 3 of the 16 patients [128,129]. However, the impact on survival or tumor size needs further evaluation.…”

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“…For percutaneous RFA of unresectable pancreatic cancer, a systematic review of 5 pilot series (n = 158) reported feasibility, a median survival after RFA of 3 -33 months, and a procedurerelated morbidity and mortality of 4 -37 % and 0 -19 %, respectively [355,356]. The results and safety of EUS-guided RFA (liver, pancreas, lymph nodes) have been evaluated only in animal experiments with encouraging results [357 -361], and only in a few human patients with pancreatic tumors [362,363]. The combination of cryotherapy and RFA has the advantage of the two technologies: the more effective cooling by cryogenic gas permits more RF-induced interstitial devitalizing effects than heat alone.…”

“…The effect of this treatment was difficult to determine. Although severe procedure-related adverse events were not observed, only 6 patients seemed to benefit from partial tumor regression [363]. Experimental studies have been performed for EUS-guided photodynamic therapy and Nd:YAG-laser treatment [364 -367].…”