title: Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook.
abstract: Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting. Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches, and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Signoretti
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Valente
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.affiliation: Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Carrara
keywords: Alcohol ablation; Chemoablation; Cryoablation; Endoscopic ablation; Endoscopic retrograde cholagiopancreatography; Endoscopic ultrasound; Endoscopic ultrasound-guided ablation; Ethanol; Pancreatic cancer; Pancreatic cystic neoplasm; Pancreatic endocrine tumours; Radiofrequency ablation