title: Ablation of pancreatic cystic lesions: the use of multiple endoscopic ultrasound-guided ethanol lavage sessions.
abstract: OBJECTIVE
  Determine the effectiveness of multiple endoscopic ultrasound-guided ethanol lavage (EUS-EL) sessions for attempted ablation of pancreatic cystic lesion (PCL).
  
  
  METHODS
  Retrospective review of patients who have undergone 2 or more EUS-EL treatments of a PCL. Eligible patients had asymptomatic, benign-appearing PCL, no previous pancreatitis, and were considered poor surgical candidates.
  
  
  RESULTS
  Final analysis was performed on 13 patients with suspected branch duct intraductal papillary mucinous neoplasms. The mean maximum cyst diameter at baseline and after 1 and 2 EUS-EL treatments was 20.1 ± 7.1, 17.0 ± 9.8 (P = 0.06), and 12.8 ± 9.6 mm (P = 0.0002), respectively. The mean surface area after 2 EUS-EL sessions: baseline, 5734 ± 6846 mm(2); 1 EUS-EL session, 4906 ± 9240 mm(2) (P = 0.52); and 2 EUS-EL sessions, 2311 ± 4093 mm(2) (P = 0.008). Complete resolution of the cystic lesion was not seen by computed tomography or magnetic resonance imaging in any patient after 1 EUS-EL but occurred in 5 (38%; P = 0.02) of 13 patients after 2 EUS-EL treatments. One patient had minor abdominal pain 1 day after the first EUS-EL session and 2 days after the second session.
  
  
  CONCLUSIONS
  Compared with only 1 EUS-EL, 2 EUS-EL treatment results in a significantly greater decrease in the size and surface area of PCL and is associated with a significantly higher rate of image-defined cyst resolution.
authors.affiliation: Gastroenterology and Nutrition Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. dimaioc@mskcc.org
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D020420:Cyst Fluid / Q000000981:diagnostic imaging / Q000378:metabolism; D016145:Endoscopy, Digestive System; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen; D000431:Ethanol