Paik Woo Hyun, Seo Dong Wan, Dhir Vinay, Wang Hsiu-Po
From the Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (WHP, DWS); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (WHP); Baldota Institute of Digestive Science, Global Hospital, Mumbai, India (VD); and Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan (H-PW).
Medicine (Baltimore). 2016 Jan;95(4):e2538. doi: 10.1097/MD.0000000000002538.
The strategy for treating small borderline malignant pancreatic neoplasms--such as neuroendocrine tumor (NET) and solid pseudopapillary neoplasm (SPN)--is surgical resection. However, pancreatic resection of these lesions still causes significant morbidity. We evaluated the safety and efficacy of EUS-guided ethanol ablation to treat small solid pancreatic neoplasms. A total of 8 patients with small borderline malignant pancreatic neoplasms and co-morbidities who refused surgery were included. We identified 2 cases of nonfunctioning NET, 3 cases of insulinomas, 1 case of gastrinoma, and 2 cases of SPN. EUS-guided ethanol ablation was performed, and treatment outcomes were assessed with clinical symptom, hormone assay, and imaging study. The mean tumor diameter was 15 mm (range, 7-29 mm), and the median volume of injected ethanol was 2.8 mL (range, 1.2-10.5 mL). There was 1 severe acute pancreatitis after EUS-guided ethanol ablation with 20-gauge CPN needle. During follow-up (median 16.5 months), 6 patients achieved treatment success; however, 2 patients (1 nonfunctioning NET and 1 SPN) still had persistent tumors. The patient with persistent SPN underwent surgical resection and the histopathological results showed peripancreatic infiltration with perineural invasion. Among 6 patients who achieved initial treatment success, 1 patient experienced tumor recurrence within 15 months and underwent repeated EUS-guided ethanol ablation. In conclusion, EUS-guided ethanol ablation therapy is a promising option for patients with small solid pancreatic neoplasm. Multiple sessions or surgical interventions may be required if there is a recurrent or persistent mass, and procedure-related adverse events must be carefully monitored.
治疗小的交界性恶性胰腺肿瘤（如神经内分泌肿瘤（NET）和实性假乳头状肿瘤（SPN））的策略是手术切除。然而，对这些病变进行胰腺切除仍会导致明显的发病率。我们评估了超声内镜引导下乙醇消融治疗小的实性胰腺肿瘤的安全性和有效性。总共纳入了8例患有小的交界性恶性胰腺肿瘤且有合并症并拒绝手术的患者。我们确定了2例无功能性NET、3例胰岛素瘤、1例胃泌素瘤和2例SPN。进行了超声内镜引导下乙醇消融，并通过临床症状、激素测定和影像学检查评估治疗效果。肿瘤平均直径为15毫米（范围7 - 29毫米），注入乙醇的中位体积为2.8毫升（范围1.2 - 10.5毫升）。使用20号CPN针进行超声内镜引导下乙醇消融后发生了1例严重急性胰腺炎。在随访期间（中位时间16.5个月），6例患者治疗成功；然而，2例患者（1例无功能性NET和1例SPN）仍有持续性肿瘤。患有持续性SPN的患者接受了手术切除，组织病理学结果显示胰腺周围浸润伴神经周围侵犯。在6例初始治疗成功的患者中，1例患者在15个月内出现肿瘤复发并接受了重复的超声内镜引导下乙醇消融。总之，超声内镜引导下乙醇消融治疗对于小的实性胰腺肿瘤患者是一个有前景的选择。如果有复发或持续性肿块，可能需要多次治疗或手术干预，并且必须仔细监测与操作相关的不良事件。
