Attila Tan, Adsay Volkan, Faigel Douglas O
Department of Internal Medicine, Division of Gastroenterology and Hepatology.
Department of Internal Medicine, American Hospital, Division of Gastroenterology and Hepatology, Istanbul, Turkey.
Eur J Gastroenterol Hepatol. 2019 Jan;31(1):1-9. doi: 10.1097/MEG.0000000000001297.
Endoscopic ultrasound (EUS)-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens are investigative modalities. To evaluate the safety and efficacy of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens. A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens from January 1980 to February 2018. EUS-guided cyst ablation-related outcomes (cyst resolution) and complications. Data were extracted from six studies (N=207 patients) for EUS-guided cyst ablation with alcohol lavage and eight studies (N=347 patients) for EUS-guided cyst ablation with paclitaxel-based regimens. The pooled proportion of patients with complete cyst resolution was 68/207 (32.8%) for EUS-guided cyst ablation with alcohol lavage and 221/347 (63.6%) for EUS-guided cyst ablation with paclitaxel. Postablation adverse events with EUS-guided ablation with alcohol lavage were 44/207 (21.7%), and those with EUS-guided ablation with paclitaxel-based regimens were 52/347 (15%). Limitations of this study are because of the variability in study design and regimens tested, paucity of randomized trials, and differences in pancreatic cyst types receiving treatment. EUS-guided cyst ablation appears to be effective and safe. The effect on pancreatic cancer incidence is unknown; EUS-guided pancreatic cyst ablation modalities require further improvement and validation to determine their role in the treatment of patients with pancreatic cystic lesions.
内镜超声（EUS）引导下酒精灌洗或基于紫杉醇的方案进行胰腺囊肿消融是研究性的治疗方式。为评估EUS引导下酒精灌洗或基于紫杉醇的方案进行胰腺囊肿消融的安全性和有效性。对计算机化文献数据库进行了系统回顾，以查找1980年1月至2018年2月期间关于EUS引导下酒精灌洗或基于紫杉醇的方案进行胰腺囊肿消融的研究。EUS引导下囊肿消融相关的结果（囊肿消退）和并发症。从6项研究（N = 207例患者）中提取了关于EUS引导下酒精灌洗囊肿消融的数据，从8项研究（N = 347例患者）中提取了关于EUS引导下基于紫杉醇方案囊肿消融的数据。EUS引导下酒精灌洗囊肿消融患者完全囊肿消退的合并比例为68/207（32.8%），EUS引导下紫杉醇囊肿消融患者为221/347（63.6%）。EUS引导下酒精灌洗消融术后不良事件为44/207（21.7%），EUS引导下基于紫杉醇方案消融术后不良事件为52/347（15%）。本研究的局限性在于研究设计和测试方案的变异性、随机试验的缺乏以及接受治疗的胰腺囊肿类型的差异。EUS引导下囊肿消融似乎是有效和安全的。对胰腺癌发病率的影响尚不清楚；EUS引导下胰腺囊肿消融方式需要进一步改进和验证，以确定其在胰腺囊性病变患者治疗中的作用。
