The Safety and Efficacy of an Alcohol-Free Pancreatic Cyst Ablation Protocol

Abstract

In this prospective, randomized, controlled trial, we found that alcohol is not required for effective EUS-guided pancreatic cyst ablation, and when alcohol is removed from the ablation process, there is a significant reduction in associated adverse events. A multi-agent chemotherapeutic ablation admixture did not appear to significantly improve rates of complete ablation compared with the current standard of alcohol lavage followed by paclitaxel alone. ClinicalTrials.gov ID: NCT01475331.

Endoscopic Pancreato-Biliary Interventions

“…In this randomized double-blind prospective trial, infusion of the chemotherapeutic agent mixed with saline had less adverse reactions compared with alcohol mixed with chemotherapeutic cocktail. 62 At the end of 12 months, the overall complete cyst resolution was 64% (67% in alcohol-free group and 61% in alcohol group), which was not statistically significant between both groups. Pancreatic cyst ablation has been described using the monopolar RFA probe (Habib EUS RFA catheter).…”

Pancreatitis kills cysts: A phenomenon that illustrates the potential role of immune activation in premalignant cyst ablation

“…Pancreatic cystic lesions (PCLs) are being increasingly recognized on imaging studies, with prevalence increasing with age and ranging from 2 % to 37 % [1]. Mucinous cysts, including mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs), are the most prevalent type of pancreatic cysts and are at risk of progressing into invasive carcinoma.…”

“…These cysts require further management, yet current strategies including radiographic surveillance and surgical resection present their own set of difficulties. Radiographic surveillance is associated with high cost, radiation exposure, and offers no definitive treatment, and surgical resection carries substantial risk for serious adverse events (AEs) (20 %-40 %) and mortality (1 %-3 %) [1]. Endoscopic ultrasound (EUS)-guided fine needle infusion is an evolving and promising method for chemically ablating appropriately selected mucinous type pancreatic cysts with an endoscopic, minimally invasive technique that carries complete ablation rates ranging from 50 % to 79 % [2][3][4].…”

“…Endoscopic ultrasound (EUS)-guided fine needle infusion is an evolving and promising method for chemically ablating appropriately selected mucinous type pancreatic cysts with an endoscopic, minimally invasive technique that carries complete ablation rates ranging from 50 % to 79 % [2][3][4]. Rates of associated serious AEs for EUS-guided chemoablation range from 0 % using an alcohol-free technique to as high as 10 % when alcohol is used in the ablation process [1][2][3][4]. The most common AE is pancreatitis, which is believed to be due to the inflammatory and toxic effects of the dehydrated alcohol [1].…”

“…Rates of associated serious AEs for EUS-guided chemoablation range from 0 % using an alcohol-free technique to as high as 10 % when alcohol is used in the ablation process [1][2][3][4]. The most common AE is pancreatitis, which is believed to be due to the inflammatory and toxic effects of the dehydrated alcohol [1].…”