Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel.
Endoscopy
; 46(6): 457-64, 2014 Jun.
Article
in En
| MEDLINE
| ID: mdl-24770971
ABSTRACT
BACKGROUND AND STUDY AIMS:
Endoscopic ultrasound (EUS)-guided ethanol lavage with paclitaxel injection has been shown to be effective for the treatment of pancreatic cystic neoplasms; however, the evidence for effectiveness is based primarily on cyst resolution on imaging. The aim of this study was to evaluate changes in pancreatic cyst fluid DNA following EUS-guided pancreatic cyst ablation (PCA) with ethanol and paclitaxel. PATIENTS ANDMETHODS:
In a single-center, prospective study, patients with suspected benign pancreatic cysts (15â-â50âmm in diameter; ≤â5 compartments) underwent EUS-PCA with ethanol and paclitaxel followed 3 months later by repeat EUS-FNA, cyst aspiration for repeat DNA analysis, and possible repeat EUS-PCA. Abdominal imaging was repeated 3â-â4 months and 12 months after the second EUS.âChanges in baseline pancreatic cyst fluid DNA, procedural complications, and radiographic changes in cyst volume were evaluated.RESULTS:
A total of 22 patients (median age 67 years; 15 women) with cysts in the head or uncinate (nâ=â10), body or neck (nâ=â8), and tail (nâ=â4), measuring a median diameter of 25âmm (range 15â-â43âmm), underwent one (nâ=â22) or two (nâ=â9) EUS-PCA procedures. Baseline cyst DNA included mutations in 11 patients (50â%). Postablation cyst fluid (nâ=â19) showed elimination of all baseline mutations in eight patients, new mutations in three, and no changes in eight without a baseline mutation. The largest per-protocol postablation image-defined volume change (nâ=â20) from either of the follow-up abdominal imaging studies (nâ=â20) demonstrated complete response (â<â5â% original volume) in 10 patients (50â%), partial response (5â%â-â25â% original volume) in 5 (25â%), and a persistent cyst (>â25â% original volume) in 5 (25â%). During a median follow-up of 27 months (range 17â-â42 months), adverse events from all EUS-PCAs (nâ=â31) included abdominal pain alone in four patients (13â%), pancreatitis in three (10â%), peritonitis in one (3â%), and gastric wall cyst in one (3â%). The adverse events were classified as moderately severe in four patients (three with pancreatitis, one with peritonitis).CONCLUSION:
EUS-PCA with ethanol and paclitaxel may possibly eliminate mutant DNA in neoplastic pancreatic cysts. This technique leads to complete or partial image-defined resolution in 75â% of cysts but may lead to rare adverse events. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01643460).
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pancreatic Cyst
/
DNA
/
Cyst Fluid
/
Ablation Techniques
Type of study:
Diagnostic_studies
/
Guideline
/
Observational_studies
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Endoscopy
Year:
2014
Document type:
Article
Affiliation country:
United States