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Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel.
- Source :
-
Endoscopy [Endoscopy] 2014 Jun; Vol. 46 (6), pp. 457-64. Date of Electronic Publication: 2014 Apr 25. - Publication Year :
- 2014
-
Abstract
- Background and Study Aims: Endoscopic ultrasound (EUS)-guided ethanol lavage with paclitaxel injection has been shown to be effective for the treatment of pancreatic cystic neoplasms; however, the evidence for effectiveness is based primarily on cyst resolution on imaging. The aim of this study was to evaluate changes in pancreatic cyst fluid DNA following EUS-guided pancreatic cyst ablation (PCA) with ethanol and paclitaxel.<br />Patients and Methods: In a single-center, prospective study, patients with suspected benign pancreatic cysts (15 - 50 mm in diameter; ≤ 5 compartments) underwent EUS-PCA with ethanol and paclitaxel followed 3 months later by repeat EUS-FNA, cyst aspiration for repeat DNA analysis, and possible repeat EUS-PCA. Abdominal imaging was repeated 3 - 4 months and 12 months after the second EUS. Changes in baseline pancreatic cyst fluid DNA, procedural complications, and radiographic changes in cyst volume were evaluated.<br />Results: A total of 22 patients (median age 67 years; 15 women) with cysts in the head or uncinate (n = 10), body or neck (n = 8), and tail (n = 4), measuring a median diameter of 25 mm (range 15 - 43 mm), underwent one (n = 22) or two (n = 9) EUS-PCA procedures. Baseline cyst DNA included mutations in 11 patients (50 %). Postablation cyst fluid (n = 19) showed elimination of all baseline mutations in eight patients, new mutations in three, and no changes in eight without a baseline mutation. The largest per-protocol postablation image-defined volume change (n = 20) from either of the follow-up abdominal imaging studies (n = 20) demonstrated complete response ( < 5 % original volume) in 10 patients (50 %), partial response (5 % - 25 % original volume) in 5 (25 %), and a persistent cyst (> 25 % original volume) in 5 (25 %). During a median follow-up of 27 months (range 17 - 42 months), adverse events from all EUS-PCAs (n = 31) included abdominal pain alone in four patients (13 %), pancreatitis in three (10 %), peritonitis in one (3 %), and gastric wall cyst in one (3 %). The adverse events were classified as moderately severe in four patients (three with pancreatitis, one with peritonitis).<br />Conclusion: EUS-PCA with ethanol and paclitaxel may possibly eliminate mutant DNA in neoplastic pancreatic cysts. This technique leads to complete or partial image-defined resolution in 75 % of cysts but may lead to rare adverse events.<br />Clinical Trial Registration: ClinicalTrials.gov (NCT01643460).<br /> (© Georg Thieme Verlag KG Stuttgart · New York.)
- Subjects :
- Ablation Techniques methods
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Phytogenic administration & dosage
DNA Mutational Analysis
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Ethanol administration & dosage
Female
Humans
Male
Middle Aged
Paclitaxel administration & dosage
Pancreatic Cyst diagnostic imaging
Prospective Studies
Radiography
Solvents administration & dosage
Ablation Techniques adverse effects
Cyst Fluid chemistry
DNA analysis
Pancreatic Cyst genetics
Pancreatic Cyst surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1438-8812
- Volume :
- 46
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 24770971
- Full Text :
- https://doi.org/10.1055/s-0034-1365496