Therapeutic GI Endoscopy Unit, Campus "Bio-Medico" University, Rome, Italy.
IHU-Strasbourg, Institute of Image-Guided Surgery, IRCAD, Strasbourg, France.
Gastrointest Endosc. 2018 Jul;88(1):168-174.e1. doi: 10.1016/j.gie.2018.02.007. Epub 2018 Feb 13.
EUS has become an interventional technique in which a needle may be used as a vehicle to deliver therapeutic agents. Laser ablation (LA) has been used to treat many primary and secondary neoplasms. This study aimed to assess the feasibility of EUS-guided LA for unresectable (UR) pancreatic cancer.
Patients with stage IIb-III pancreatic cancer underwent EUS-guided LA. All patients were unresponsive to previous chemoradiotherapy. LA was performed by using a 300-μm flexible fiber preloaded onto a 22-gauge fine needle. A 1064-nm wavelength neodymium-yttrium aluminum garnet (Nd:YAG) laser light with different power settings of 2 W for 800 J, 1000 J, and 1200 J; 3 W for 800 J, 1000 J, and 1200 J; and 4 W for 800 J, 1000 J, and 1200 J was used. Each patient was treated with a single application of 1 of these settings. The application time of the power settings ranged from 200 to 600 seconds.
Nine patients (median age, 74.7; range 55-85) underwent Nd:Yag LA. The mean size of the focal lesion was 35.4 mm (range, 21-45). The ablation area, demonstrated by 24-hour CT, ranged from .4 cm (for the lower power setting of 2 W/800 J) to a maximum of 6.4 cm (for 4 W/1000 J). The procedure was completed in all 9 patients without adverse events.
In our human experience, EUS-guided LA was feasible and well tolerated in patients with UR pancreatic cancer.
EUS 已成为一种介入技术，其中可以使用针作为载体来输送治疗剂。激光消融（LA）已被用于治疗许多原发性和继发性肿瘤。本研究旨在评估 EUS 引导下 LA 治疗不可切除（UR）胰腺癌的可行性。
接受 EUS 引导下 LA 的 IIb-III 期胰腺癌患者。所有患者对先前的放化疗均无反应。LA 通过将 300μm 柔性光纤预加载到 22G 细针上进行。使用波长为 1064nm 的钕-钇铝石榴石（Nd:YAG）激光，功率设置分别为 2W/800J、1000J 和 1200J；3W/800J、1000J 和 1200J；和 4W/800J、1000J 和 1200J。每位患者接受 1 种设置的单次应用。功率设置的应用时间范围为 200-600 秒。
9 例患者（中位年龄 74.7 岁；范围 55-85 岁）接受了 Nd:Yag LA。病灶的平均大小为 35.4mm（范围 21-45）。24 小时 CT 显示消融面积为 0.4cm（最低功率设置为 2W/800J）至 6.4cm（最高功率设置为 4W/1000J）。9 例患者均顺利完成该手术，无不良事件发生。
根据我们的人类经验，EUS 引导下 LA 对不可切除的胰腺癌患者是可行的，且耐受良好。
