title: Safety and Efficacy of EUS-Guided Ethanol Ablation for Treating Small Solid Pancreatic Neoplasm.
abstract: The strategy for treating small borderline malignant pancreatic neoplasms--such as neuroendocrine tumor (NET) and solid pseudopapillary neoplasm (SPN)--is surgical resection. However, pancreatic resection of these lesions still causes significant morbidity. We evaluated the safety and efficacy of EUS-guided ethanol ablation to treat small solid pancreatic neoplasms. A total of 8 patients with small borderline malignant pancreatic neoplasms and co-morbidities who refused surgery were included. We identified 2 cases of nonfunctioning NET, 3 cases of insulinomas, 1 case of gastrinoma, and 2 cases of SPN. EUS-guided ethanol ablation was performed, and treatment outcomes were assessed with clinical symptom, hormone assay, and imaging study. The mean tumor diameter was 15  mm (range, 7-29  mm), and the median volume of injected ethanol was 2.8  mL (range, 1.2-10.5  mL). There was 1 severe acute pancreatitis after EUS-guided ethanol ablation with 20-gauge CPN needle. During follow-up (median 16.5 months), 6 patients achieved treatment success; however, 2 patients (1 nonfunctioning NET and 1 SPN) still had persistent tumors. The patient with persistent SPN underwent surgical resection and the histopathological results showed peripancreatic infiltration with perineural invasion. Among 6 patients who achieved initial treatment success, 1 patient experienced tumor recurrence within 15 months and underwent repeated EUS-guided ethanol ablation. In conclusion, EUS-guided ethanol ablation therapy is a promising option for patients with small solid pancreatic neoplasm. Multiple sessions or surgical interventions may be required if there is a recurrent or persistent mass, and procedure-related adverse events must be carefully monitored.
authors.affiliation: From the Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (WHP, DWS); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (WHP); Baldota Institute of Digestive Science, Global Hospital, Mumbai, India (VD); and Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan (H-PW).
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Paik
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D015408:Gastrinoma / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D007340:Insulinoma / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D047368:Tumor Burden; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol
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