Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts.
OBJECTIVE
Endoscopic ultrasonography (EUS)-guided interventions have been used to treat patients with cystic lesions of the pancreas (CLPs). We used EUS to guide injection and lavage of ethanol, followed by injection of paclitaxel, into cysts, and investigated treatment response and predictors.


METHODS
Fifty-two patients were enrolled in the study using the following inclusion criteria: unilocular or oligolocular cysts, indeterminate cystic lesions that required EUS fine-needle aspiration, and cystic lesions that grew during the observation period. Forty-seven patients were followed up for more than 12 months and their outcomes were analyzed.


RESULTS
The mean diameter of the CLPs was 31.8 mm (range, 17-68 mm) and the estimated volume was 14.09 mL (range, 1.16-68.74 mL). Twenty CLPs were oligolocular. The mean level of carcinoembryonic antigen was 463 ng/mL (range, 1-8190 ng/mL). The median follow-up period was 21.7 months. A complete response was observed in 29 patients, a partial response in 6 patients, and persistent cysts in 12 patients. Four of 12 patients with persistent cysts underwent surgery. The histopathologic degree of epithelial ablation varied from 0% to 100%. Based on univariate analysis, EUS diameter and original volume predicted cyst resolution; in multivariate analysis, only original volume predicted resolution. Mild pancreatitis and splenic vein obliteration each occurred in 1 patient.


CONCLUSIONS
EUS-guided injection and lavage of ethanol, followed by injection of paclitaxel, appears to be a safe method for treating pancreatic cysts; 62% of patients had complete resolution. Small cyst volume predicted complete resolution.
Oh
Hyoung-Chul
HC
Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.
Seo
Dong Wan
DW
Song
Tae Jun
TJ
Moon
Sung-Hoon
SH
Park
Do Hyun
DH
Soo Lee
Sang
S
Lee
Sung Koo
SK
Kim
Myung-Hwan
MH
Kim
Jihun
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D019160:Endosonography / Q000009:adverse effects / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D013162:Splenic Vein; D016896:Treatment Outcome; D055815:Young Adult
D002272:Carcinoembryonic Antigen; D000431:Ethanol; D017239:Paclitaxel