Carrara Silvia, Petrone Maria Chiara, Testoni Pier Alberto, Arcidiacono Paolo Giorgio
Silvia Carrara, Maria Chiara Petrone, Pier Alberto Testoni, Paolo Giorgio Arcidiacono, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy.
World J Gastrointest Endosc. 2013 Apr 16;5(4):141-7. doi: 10.4253/wjge.v5.i4.141.
With the advent of linear echoendoscopes, endoscopic ultrasound (EUS) has become more operative and a new field of oncological application has been opened up. From tumor staging to tissue acquisition under EUS-guided fine-needle aspiration, new operative procedures have been developed on the principle of the EUS-guided puncture. A hybrid probe combining radiofrequency with cryotechnology is now available, to be passed through the operative channel of the echoendoscope into the tumor to create an area of ablation. EUS-guided fine-needle injection is emerging as a method to deliver anti-tumoral agents inside the tumor. Ethanol lavage, with or without paclitaxel, has been proposed for the treatment of cystic tumors in non-resectable cases and complete resolution has been recorded in up to 70%-80%. Many other chemical or biological agents have been investigated for the treatment of pancreatic adenocarcinoma: activated allogenic lymphocyte culture (Cytoimplant), a replication-deficient adenovirus vector carrying the tumor necrosis factor-α gene, or an oncolytic attenuated adenovirus (ONYX-015). The potential advantage of treatment under EUS control is the real-time imaging guidance into a deep target like the pancreas which is extremely difficult to reach by a percutaneous approach. To date there are no randomized controlled trials to confirm the real clinical benefits of these treatments compared to standard therapy so it seems wise to reserve them only for experimental protocols approved by ethics committees.
随着线性超声内镜的出现，内镜超声（EUS）的操作性更强，并且开辟了肿瘤学应用的新领域。从肿瘤分期到EUS引导下细针穿刺获取组织，基于EUS引导穿刺的原理开发了新的手术操作。现在有一种将射频与冷冻技术相结合的混合探头，可通过超声内镜的操作通道进入肿瘤以形成消融区域。EUS引导下细针注射正在成为一种在肿瘤内部递送抗肿瘤药物的方法。对于不可切除病例的囊性肿瘤治疗，已提出使用乙醇灌洗（有无紫杉醇），并且有记录显示高达70%-80%的病例可实现完全消退。已经对许多其他化学或生物制剂用于治疗胰腺腺癌进行了研究：活化的同种异体淋巴细胞培养物（Cytoimplant）、携带肿瘤坏死因子-α基因的复制缺陷型腺病毒载体或溶瘤减毒腺病毒（ONYX-015）。EUS控制下治疗的潜在优势在于对像胰腺这样通过经皮途径极难到达的深部目标进行实时成像引导。迄今为止，尚无随机对照试验来证实这些治疗与标准治疗相比的实际临床益处，因此仅将它们保留用于伦理委员会批准的实验方案似乎是明智的。
