Endoscopic Ultrasound-Guided Ablation of Premalignant Pancreatic Cysts and Pancreatic Cancer

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2024 Mar 13

PMID 38473035

Authors

Alejandra Vargas

Priyata Dutta

Eileen S Carpenter

Jorge D Machicado

Affiliations

Soon will be listed here.

Abstract

Pancreatic cancer is on the rise and expected to become the second leading cause of cancer-related death by 2030. Up to a one-fifth of pancreatic cancers may arise from mucinous pancreatic cysts, which are frequently present in the general population. Currently, surgical resection is the only curative approach for pancreatic cancer and its cystic precursors. However, only a dismal proportion of patients are eligible for surgery. Therefore, novel treatment approaches to treat pancreatic cancer and precancerous pancreatic cysts are needed. Endoscopic ultrasound (EUS)-guided ablation is an emerging minimally invasive method to treat pancreatic cancer and premalignant pancreatic cysts. Different ablative modalities have been used including alcohol, chemotherapy agents, and radiofrequency ablation. Cumulative data over the past two decades have shown that endoscopic ablation of mucinous pancreatic cysts can lead to cyst resolution in a significant proportion of the treated cysts. Furthermore, novel data are emerging about the ability to endoscopically ablate early and locally advanced pancreatic cancer. In this review, we aim to summarize the available data on the efficacy and safety of the different EUS-ablation modalities for the management of premalignant pancreatic cysts and pancreatic cancer.

Citing Articles

Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer.

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Rogers H, Shah S Diagnostics (Basel). 2024; 14(11).

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References

Mehta A, Oklu R, Sheth R . Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response?. Gastroenterol Res Pract. 2016; 2016:9251375. PMC: 4802022. DOI: 10.1155/2016/9251375. View

Kim J, Hong S . Precursor Lesions of Pancreatic Cancer. Oncol Res Treat. 2018; 41(10):603-610. DOI: 10.1159/000493554. View

Azam F, Latif M, Farooq A, Tirmazy S, Alshahrani S, Bashir S . Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score for Cancer Patients by Oncology Healthcare Professionals. Case Rep Oncol. 2019; 12(3):728-736. PMC: 6792426. DOI: 10.1159/000503095. View

Rangwani S, Juakiem W, Krishna S, El-Dika S . Role of Endoscopic Ultrasound in the Evaluation of Pancreatic Cystic Neoplasms: A Concise Review. Diagnostics (Basel). 2023; 13(4). PMC: 9955397. DOI: 10.3390/diagnostics13040705. View

DOnofrio M, Ciaravino V, De Robertis R, Barbi E, Salvia R, Girelli R . Percutaneous ablation of pancreatic cancer. World J Gastroenterol. 2016; 22(44):9661-9673. PMC: 5124972. DOI: 10.3748/wjg.v22.i44.9661. View

Canoui-Poitrine F, Segaux L, Benderra M, About F, Tournigand C, Laurent M . The Prognostic Value of Eight Comorbidity Indices in Older Patients with Cancer: The ELCAPA Cohort Study. Cancers (Basel). 2022; 14(9). PMC: 9105640. DOI: 10.3390/cancers14092236. View

Krishna S, Ardeshna D, Shah Z, Hart P, Culp S, Jones D . Intracystic injection of large surface area microparticle paclitaxel for chemoablation of intraductal papillary mucinous neoplasms: Insights from an expanded access protocol. Pancreatology. 2024; 24(2):289-297. DOI: 10.1016/j.pan.2023.12.014. View

Sun X, Lu Z, Wu Y, Min M, Bi Y, Shen W . An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer. Oncotarget. 2017; 8(45):79099-79110. PMC: 5668023. DOI: 10.18632/oncotarget.15763. View

Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P, Bassi C . Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg. 2010; 97(2):220-5. DOI: 10.1002/bjs.6800. View

10.

Linghu E, Du C, Chai N, Li H, Wang Z, Sun Y . A prospective study on the safety and effectiveness of using lauromacrogol for ablation of pancreatic cystic neoplasms with the aid of EUS. Gastrointest Endosc. 2017; 86(5):872-880. DOI: 10.1016/j.gie.2017.03.1525. View

11.

Herranz Perez R, de la Morena Lopez F, Majano Rodriguez P, Molina Jimenez F, Vega Piris L, Santander Vaquero C . Molecular analysis of pancreatic cystic neoplasm in routine clinical practice. World J Gastrointest Endosc. 2021; 13(2):56-71. PMC: 7890406. DOI: 10.4253/wjge.v13.i2.56. View

12.

Singhi A, Koay E, Chari S, Maitra A . Early Detection of Pancreatic Cancer: Opportunities and Challenges. Gastroenterology. 2019; 156(7):2024-2040. PMC: 6486851. DOI: 10.1053/j.gastro.2019.01.259. View

13.

Wei K, Hackert T . Surgical Treatment of Pancreatic Ductal Adenocarcinoma. Cancers (Basel). 2021; 13(8). PMC: 8074119. DOI: 10.3390/cancers13081971. View

14.

Jarosova J, Macinga P, Krupickova L, Fialova M, Hujova A, Mares J . Impact of Endoluminal Radiofrequency Ablation on Immunity in Pancreatic Cancer and Cholangiocarcinoma. Biomedicines. 2022; 10(6). PMC: 9219740. DOI: 10.3390/biomedicines10061331. View

15.

Guzman-Calderon E, Martinez-Moreno B, Casellas J, de Madaria E, Aparicio J . Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review. Endosc Int Open. 2020; 8(9):E1123-E1133. PMC: 7458739. DOI: 10.1055/a-1149-1647. View

16.

Moyer M, Sharzehi S, Mathew A, Levenick J, Headlee B, Blandford J . The Safety and Efficacy of an Alcohol-Free Pancreatic Cyst Ablation Protocol. Gastroenterology. 2017; 153(5):1295-1303. DOI: 10.1053/j.gastro.2017.08.009. View

17.

Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang J, Levy P, Ohtsuka T . Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17(5):738-753. DOI: 10.1016/j.pan.2017.07.007. View

18.

Li S, Wang Z, Pan C, Wu C, Li Z, Jin Z . Comparative Performance of Endoscopic Ultrasound-Based Techniques in Patients With Pancreatic Cystic Lesions: A Network Meta-Analysis. Am J Gastroenterol. 2022; 118(2):243-255. DOI: 10.14309/ajg.0000000000002088. View

19.

Sharma R, Bush N, Rana S, Srinivasan R, Nada R, Gupta R . Lower cyst fluid carcinoembryonic antigen cutoff is helpful in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts. Indian J Gastroenterol. 2022; 41(4):397-404. DOI: 10.1007/s12664-022-01269-w. View

20.

Prete A, Gonda T . Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature. J Clin Med. 2023; 12(9). PMC: 10179349. DOI: 10.3390/jcm12093325. View