Moyer Matthew T, Maranki Jennifer L, DeWitt John M
Division of Gastroenterology and Hepatology, Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, USA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Curr Gastroenterol Rep. 2019 Apr 23;21(5):19. doi: 10.1007/s11894-019-0686-5.
Pancreatic cystic lesions represent a growing public health dilemma, particularly as our population ages and cross-sectional imaging becomes more sensitive. Mucinous cysts carry a clinically significant risk of developing pancreatic cancer, which carries an extremely poor prognosis. Determining which cysts will develop cancer may be challenging, and surgical resection of the pancreas carries significant morbidity. The goal of this paper is to review the rationale for cyst ablation and discuss prior and current research on cyst ablation techniques and efficacy. Indications, contraindications, and factors related to optimal patient selection are outlined.
Endoscopic ultrasound-guided chemoablation of pancreatic cysts has been performed in neoplastic cysts, with varying levels of efficacy. Safety concerns arose due to the risk of pancreatitis in alcohol-based treatments; however, the most recent data using a non-alcohol chemoablation cocktail suggests that ablation is effective without the need for alcohol, resulting in a significantly more favorable adverse event profile. Endoscopic ultrasound-guided chemoablation of neoplastic pancreatic cysts is a promising, minimally invasive approach for treatment of cysts, with recent significant advances in safety and efficacy, suggesting that it should play a role in the treatment algorithm.
胰腺囊性病变给公共卫生带来了日益严峻的难题,尤其是随着人口老龄化以及横断面成像技术变得更加灵敏。黏液性囊肿具有发展为胰腺癌的显著临床风险,而胰腺癌的预后极差。确定哪些囊肿会发展为癌症可能具有挑战性,并且胰腺手术切除会带来较高的发病率。本文的目的是回顾囊肿消融的理论依据,并讨论既往和当前关于囊肿消融技术及疗效的研究。概述了适应证、禁忌证以及与最佳患者选择相关的因素。
已对肿瘤性囊肿进行了内镜超声引导下的胰腺囊肿化学消融,疗效各异。基于酒精的治疗存在胰腺炎风险,引发了对安全性的担忧;然而,使用非酒精化学消融合剂的最新数据表明,无需酒精即可实现有效消融,不良事件谱明显更有利。内镜超声引导下对肿瘤性胰腺囊肿进行化学消融是一种有前景的微创囊肿治疗方法,近期在安全性和疗效方面取得了重大进展,表明其应在治疗方案中发挥作用。