Park Joo Kyung, Song Byeong Jun, Ryu Ji Kon, Paik Woo Hyun, Park Jin Myung, Kim Jaihwan, Lee Sang Hyub, Kim Yong-Tae
From the *Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; †Myongji Hospital, Goyang, Gyeonggi; ‡Division of Gastroenterology, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Pancreas. 2016 Jul;45(6):889-94. doi: 10.1097/MPA.0000000000000567.
Endoscopic ultrasonography-guided ethanol ablation therapy for pancreatic cystic lesions is a minimally invasive treatment but still is an experimental therapy. The aims were to investigate the safety and efficacy of endoscopic ultrasonography-guided ethanol ablation therapy.
The inclusion criteria were the following: clinically indeterminate pancreatic cystic lesions in radiologic imaging studies, 2 to 5 cm unilocular or oligolocular cysts without communication to main pancreatic duct, and patients with high-risk operation.
There were 91 study patients with median follow-up of 40 months. The response rate was as follows: complete resolution, 41 (45%); partial resolution, 37; and persistent cysts, 13. Pancreatic cystic lesions were categorized based on cystic fluid analysis: 9 intraductal papillary mucinous neoplasms (IPMNs), 12 mucinous cystic neoplasms, 33 serous cystic neoplasms, and 28 uncategorized cysts. The success rate was significantly different according to cystic fluid analysis (serous cystic neoplasm, 58%; mucinous cystic neoplasm, 50%; IPMN, 11%; uncategorized cysts, 39%; P < 0.0001). There were 3 patients with mild pancreatitis after the treatment.
Endoscopic ultrasonography-guided ethanol ablation therapy seems to be a safe treatment modality. However, it was only effective in 11% of IPMNs. Therefore, the clinical application should be very limited for certain patients who could not tolerate the surgical treatment.
内镜超声引导下乙醇消融治疗胰腺囊性病变是一种微创治疗方法，但仍属实验性治疗。本研究旨在探讨内镜超声引导下乙醇消融治疗的安全性和有效性。
纳入标准如下：影像学检查中临床诊断不明确的胰腺囊性病变；直径2至5厘米的单房或多房囊肿，且与主胰管无交通；具有高手术风险的患者。
共有91例研究患者，中位随访时间为40个月。治疗有效率如下：完全缓解41例（45%），部分缓解37例，囊肿持续存在13例。根据囊液分析对胰腺囊性病变进行分类：9例导管内乳头状黏液性肿瘤（IPMN），12例黏液性囊性肿瘤，33例浆液性囊性肿瘤，28例未分类囊肿。根据囊液分析，成功率有显著差异（浆液性囊性肿瘤为58%；黏液性囊性肿瘤为50%；IPMN为11%；未分类囊肿为39%；P < 0.0001）。治疗后有3例患者发生轻度胰腺炎。
内镜超声引导下乙醇消融治疗似乎是一种安全的治疗方式。然而，其仅对11%的IPMN有效。因此，对于无法耐受手术治疗的特定患者，其临床应用应非常有限。
