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World J Gastroenterol. Jun 21, 2020; 26(23): 3213-3224
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3213
Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms
Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng
Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Du C and Chai NL contributed equally to this article; Du C and Chai NL contributed to this paper with conception and design of the study; Du C, Chai NL, Li HK, and Feng XX did the literature review and analysis; Du C and Linghu EQ wrote the paper; all authors made the critical revision and editing of the article for important intellectual content, and approved the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: En-Qiang Linghu, MD, PhD, Chief Doctor, Chief Physician, Director, Professor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: January 13, 2020
Peer-review started: January 13, 2020
First decision: April 8, 2020
Revised: April 24, 2020
Accepted: May 22, 2020
Article in press: May 22, 2020
Published online: June 21, 2020
Abstract

With the development of cross-sectional imaging modalities and the increasing attention being paid to physical examinations, the prevalence of pancreatic cystic neoplasms (PCNs) has increased. PCNs comprise a broad differential spectrum with some PCNs having low or no malignant potential and others having high malignant potential. The morbidity and mortality rates related to major pancreatic surgical resection are high. Long-term surveillance may not only increase the financial burden and psychological stress for patients but also result in a missed malignancy. Minimally invasive endoscopic ultrasound (EUS)-guided ethanol ablation was first reported in 2005. Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs. These ablative agents are injected through a needle inserted into the cyst via transgastric or transduodenal puncture. This treatment method has been substantially developed in the last 15 years and is regarded as a promising treatment to replace surgical resection for PCNs. While several reviews of EUS-guided ablation have been published, no systematic review has evaluated this method from patient preparation to follow-up in detail. In the present review, we systematically describe EUS-guided injective ablation with regard to the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives.

Keywords: Endoscopic ultrasound-guided ablation, Pancreatic cystic neoplasm, Ethanol, Paclitaxel, Lauromacrogol, Gemcitabine

Core tip: Endoscopic ultrasound (EUS)-guided ethanol ablation was initially reported as a minimally invasive procedure to treat pancreatic cystic neoplasms (PCNs) in 2005. Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs. This treatment method has undergone much development over 15 years and is regarded as a promising treatment to replace surgical resection for PCNs. In the present review, we systematically describe the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives of EUS-guided injective ablation.