Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation.
BACKGROUND
EUS-guided ablation of pancreatic cysts is a minimally invasive technique with reported short-term, CT-defined cyst resolution rates of 33% to 79%. Follow-up results of image-defined, successful pancreatic cyst ablation are not known.


OBJECTIVE
To determine the durability of successful cyst resolution after EUS-guided ethanol lavage.


METHODS
Prospective cohort study.


METHODS
Two tertiary-care referral hospitals in the United States.


METHODS
This study involved 12 patients with 1-to-5-cm, unilocular, pancreatic cysts that had previously resolved after ethanol lavage.


METHODS
Follow-up CT after cyst resolution.


METHODS
The presence or absence of residual pancreatic cysts by CT scanning after previous successful ablation.


RESULTS
In a previously reported trial, we found that CT scanning documented pancreatic cyst resolution in 12 patients (33%) after one (n = 6) or two (n = 6) ethanol lavages. These 12 cysts (median diameter 18 mm; range 10-34 mm) were located in the head/uncinate of the pancreas in 6 patients (50%) and in the body of the pancreas in 6 patients (50%). The median cyst fluid carcinoembryonic antigen (CEA) level (available in 11 patients) was 463 ng/mL (range 1.6-64,550 ng/mL; normal, 0-2.5 ng/mL). Clinical diagnoses were mucinous cystic neoplasm (MCN) in 9 patients, intraductal papillary mucinous neoplasm in 1 patient, pseudocyst in 1 patient, and serous cystadenoma (SCA) in 1 patient. Follow-up CT in 3 patients (one each of MCN, SCA, and pseudocyst) after the initial diagnosis of cyst resolution was not available. For the remaining 9 patients (75%), follow-up CT performed in a median of 26 months (range 13-39 months) after initial documentation of cyst resolution demonstrated no evidence of cyst recurrence in any patient.


CONCLUSIONS
Loss to follow-up of some of the cohort.


CONCLUSIONS
Follow-up after successful EUS-guided ethanol ablation of pancreatic cysts, including suspected mucinous cysts, suggests a durable, image-defined resolution. Longer follow-up in these patients is needed before considering these patients "cured" of their disease.
DeWitt
John
J
Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
DiMaio
Christopher J
CJ
Brugge
William R
WR
D002272:Carcinoembryonic Antigen / Q000032:analysis; D017115:Catheter Ablation / Q000379:methods*; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging / Q000628:therapy*; D012008:Recurrence; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D002272:Carcinoembryonic Antigen; D000431:Ethanol