Ethanol lavage of pancreatic cystic lesions: initial pilot study.
BACKGROUND
Ethanol lavage has been used to successfully and safely ablate cystic lesions of the liver, the kidneys, and the thyroid.


METHODS
Asymptomatic patients who undergo EUS examination for a pancreatic cystic lesion were eligible. Patients underwent complete examination with a linear-array echoendoscope, and cyst characteristics were documented. After evacuation of the cyst with needle aspiration, the cyst cavity was lavaged with ethanol for 3 to 5 minutes. The concentration (5%-80%) of ethanol was gradually increased over the course of the study. Patients were monitored for complications during 2 hours after the procedure, and further follow-up was obtained at 72 hours and 1 year after lavage.


METHODS
Twenty-five patients were enrolled, 80% were women, and the mean age of all patients was 64.5 years. Cysts had a mean diameter of 19.4 mm and were equally located in the head, the body, and the tail of the pancreas. Cyst-fluid characteristics included high viscosity in 13 (52%) and a mean carcinoembryonic antigen and amylase of 5916 ng/mL and 11,506 U/L, respectively. None of the patients reported any symptoms in short- and long-term follow-up. Of the 23/25 patients with complete follow-up, 8 patients (35%) had complete resolution of their cysts on follow-up imaging. Five patients underwent resection, and histologic evidence of epithelial ablation was seen.


CONCLUSIONS
Ethanol lavage of pancreatic cystic lesions is safe and feasible. A subset of patients undergoing ethanol lavage appears to have long-term resolution on follow-up imaging. Further prospective studies are required to determine if ethanol lavage is an effective treatment for pancreatic cystic lesions.
Gan
S Ian
SI
Gastrointestinal Unit, Department of Pathology, Massachusetts General Hospital, Boston, 02114, USA.
Thompson
Christopher C
CC
Lauwers
Gregory Y
GY
Bounds
Brenna C
BC
Brugge
William R
WR
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019160:Endosonography; D000431:Ethanol / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D012449:Safety; D013396:Suction / Q000379:methods; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D000431:Ethanol