title: Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer.
abstract: BACKGROUND
  New therapies are needed for pancreatic cancer.
  
  
  OBJECTIVE
  To determine the feasibility and safety of a new endoscopic treatment. Secondary endpoints were to determine effects on tumor growth measured with CT scan and to find the overall survival.
  
  
  METHODS
  A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance.
  
  
  METHODS
  San Raffaele Hospital, Milan, Italy; University Medical Center, Hamburg-Eppendorf, Germany.
  
  
  METHODS
  A total of 22 patients (male/female 11/11; mean age 61.9 years) were enrolled from September 2009 to May 2011.
  
  
  METHODS
  Radiofrequency heating: 18 W; pressure for cooling: 650 psi (Pounds per Square Inch); application time: depending on tumor size.
  
  
  METHODS
  Feasibility was evaluated during the procedure. A clinical and radiologic follow-up was planned.
  
  
  RESULTS
  The CTP was successfully applied in 16 patients (72.8%); in 6 it was not possible because of stiffness of the GI wall and of the tumor. Amylase arose in 3 of 16 patients; none had clinical signs of pancreatitis. Late complications arose in 4 cases: 3 were mostly related to tumor progression. Median postablation survival time was 6 months. A CT scan was performed in all patients, but only in 6 of 16 was it possible to clearly define the tumor margins after ablation. In these patients, the tumor appeared smaller compared with the initial mass (P = .07).
  
  
  CONCLUSIONS
  Small sample of patients, difficulty of objectifying the size of the ablated zone by CT scan.
  
  
  CONCLUSIONS
  EUS-guided CTP ablation is feasible and safe. Further investigations are needed to demonstrate progression-free survival and local control.
authors.affiliation: Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University-Scientific Institute San Raffaele, Milan, Italy. arcidiacono.paologiorgio@hsr.it
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.forename: Silvia
authors.initials: S
authors.lastname: Carrara
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.forename: Stefano
authors.initials: S
authors.lastname: Cappio
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Cinzia
authors.initials: C
authors.lastname: Boemo
authors.forename: Stefano
authors.initials: S
authors.lastname: Cereda
authors.forename: Roberto
authors.initials: R
authors.lastname: Nicoletti
authors.forename: Markus Dominik
authors.initials: MD
authors.lastname: Enderle
authors.forename: Alexander
authors.initials: A
authors.lastname: Neugebauer
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant; D003452:Cryosurgery / Q000379:methods*; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional