New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection.

BACKGROUND

Cystic tumors of the pancreas are frequently detected and encompass a wide pathologic spectrum, ranging from benign to malignant. A substantial proportion of cystic tumors cannot be histologically classified, even after extensive diagnostic evaluation, and, therefore, ultimately require surgical resection. Recently, complete resolution of cystic tumors by EUS-guided ethanol lavage was reported in a pilot study.

OBJECTIVES

The aim of this study was to evaluate the safety, feasibility, and response after EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) for cystic tumors of the pancreas.

DESIGN

A prospective study.

SETTING

A tertiary care, academic medical center, from July 2005 to November 2006.

PATIENTS

Fourteen patients who underwent EUS-EP were observed for more than 6 months. They were analyzed in terms of procedure safety, feasibility, and response.

INTERVENTION

EUS-EP.

MAIN OUTCOME MEASUREMENTS

To compare changes of cyst volume before and after an EUS-EP.

RESULTS

An EUS-EP was successfully performed in all cases except one patient in whom the cyst fluid was so viscous that it could not be sufficiently aspirated. Acute pancreatitis occurred in one patient, and minor complications, including hyperamylasemia (n = 6) and vague abdominal pain (n = 1), were observed. Complete resolution of a cystic tumor was observed in 11 patients and partial resolution in two patients, and a cyst persisted in one patient.

LIMITATIONS

A small patient number, a short follow-up time, a single treatment arm.

CONCLUSIONS

EUS-EP appears to be a safe, feasible, and effective method for treating cystic tumors of the pancreas. Further studies that involve larger populations and longer follow-ups are warranted.