Systemic effect of endoscopic ultrasonography-guided pancreatic cyst ablation with ethanol and paclitaxel.
BACKGROUND
Endoscopic ultrasonography (EUS)-guided pancreatic cyst ablation is a minimally invasive treatment modality. Local injection of ablative agents may rarely cause systemic effects in patients.


OBJECTIVE
This study aimed to evaluate the systemic effect of ablative agents by analyzing the plasma drug concentration.


METHODS
Ten patients with pancreatic cysts were enrolled. Cyst ablation was performed by 99 % ethanol lavage (2.5-70 mL) and paclitaxel (Genexol-polymeric micelle, 6.0-24.0) injection. Blood samples were collected at 0, 2, 4, 7 and 24 h. Plasma paclitaxel concentration was analyzed by a liquid chromatography-tandem mass spectrometry with the lowest limit of quantitation of 0.1 ng/mL. Procedure-related complications were closely monitored.


RESULTS
Pancreatic cysts were located at the head in two, body in seven and tail in one patient. Eight cysts were septated. Median diameter and original volume were 39.5 mm (range 2.7-21.8) and 14.79 mL (3.42-343.30). Median cyst fluid CEA and amylase values were 17.10 ng/mL (0.5-14127.5) and 73.50 U/L (3.1-91,590). Peak plasma paclitaxel concentration values were observed between 2 and 7 h, ranging from 0.45 to 14.73 ng/mL. The highest concentration (17.10 ng/mL at 0 h) was observed in a patient who had intracystic bleeding. Mild abdominal pain occurred in five patients and vomiting in one patient during the first 48-h monitoring.


CONCLUSIONS
Plasma paclitaxel concentration after EUS-guided pancreatic cyst ablation was nearly as low as the undetectable value and rarely caused systemic side-effect.
Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.
Hyoung-Chul
HC
Oh
Dong Wan
DW
Seo
Su-Hui
SH
Kim
Bumchan
B
Min
Jiyeong
J
Kim
D015746:Abdominal Pain / Q000139:chemically induced; D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D002853:Chromatography, Liquid; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D010181:Pancreatic Cyst / Q000601:surgery*; D053719:Tandem Mass Spectrometry; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D018084:Ultrasonography, Interventional; D014839:Vomiting / Q000139:chemically induced
D050257:Tubulin Modulators; D000431:Ethanol; D017239:Paclitaxel