title: Endoscopic ultrasound-guided ethanol ablation of a large metastatic carcinoid tumor: success with a note of caution.
abstract: Endoscopic ultrasonography with fine needle infusion (EUS-FNI) of alcohol is the most reported method for EUS-guided tumor ablation. Several studies have reported successful EUS-guided ablation of pancreatic neuroendocrine tumors. However, these tumors have been relatively small (< 3 cm). In this report, a 50-year-old man with a metastatic carcinoid tumor with a large porta hepatis mass was referred to our clinic for EUS-guided ethanol ablation. After two separate EUS-FNI ablations, there was a 36 % reduction in tumor size (9.0 × 11.4 cm to 6.7 × 9.8 cm) with associated tumor lysis syndrome. Chromogranin A levels decreased from 460 to 132 ng/mL. The patient reported complete resolution of abdominal pain within 2 weeks, but only mild improvement in flushing and diarrhea. In conclusion, large metastatic neuroendocrine tumors can be successfully treated with EUS-guided ethanol ablation. Evidence-based guidelines are needed with regard to the appropriate volume of ethanol injected in EUS-guided ablation to promote the efficacy and safety of this emerging procedure.
authors.affiliation: Penn State Hershey Medical Center - Internal Medicine, Hershey, Pennsylvania, United States.
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Mathers
authors.affiliation: Penn State Hershey Medical Center - Hematology and Oncology, Hershey, Pennsylvania, United States.
authors.forename: Harold A
authors.initials: HA
authors.lastname: Harvey
authors.affiliation: Penn State Hershey Medical Center - Gastroenterology and Hepatology, Hershey, Pennsylvania, United States.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Dye
authors.affiliation: Penn State Hershey Medical Center - Gastroenterology and Hepatology, Hershey, Pennsylvania, United States.
authors.forename: Brandy
authors.initials: B
authors.lastname: Dougherty-Hamod
authors.affiliation: Penn State Hershey Medical Center - Gastroenterology and Hepatology, Hershey, Pennsylvania, United States.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Moyer