Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation.

Abstract

BACKGROUND:

EUS-guided ablation of pancreatic cysts is a minimally invasive technique with reported short-term, CT-defined cyst resolution rates of 33% to 79%. Follow-up results of image-defined, successful pancreatic cyst ablation are not known.

OBJECTIVE:

To determine the durability of successful cyst resolution after EUS-guided ethanol lavage.

DESIGN:

Prospective cohort study.

SETTING:

Two tertiary-care referral hospitals in the United States.

PATIENTS:

This study involved 12 patients with 1-to-5-cm, unilocular, pancreatic cysts that had previously resolved after ethanol lavage.

INTERVENTIONS:

Follow-up CT after cyst resolution.

MAIN OUTCOME MEASUREMENTS:

The presence or absence of residual pancreatic cysts by CT scanning after previous successful ablation.

RESULTS:

In a previously reported trial, we found that CT scanning documented pancreatic cyst resolution in 12 patients (33%) after one (n = 6) or two (n = 6) ethanol lavages. These 12 cysts (median diameter 18 mm; range 10-34 mm) were located in the head/uncinate of the pancreas in 6 patients (50%) and in the body of the pancreas in 6 patients (50%). The median cyst fluid carcinoembryonic antigen (CEA) level (available in 11 patients) was 463 ng/mL (range 1.6-64,550 ng/mL; normal, 0-2.5 ng/mL). Clinical diagnoses were mucinous cystic neoplasm (MCN) in 9 patients, intraductal papillary mucinous neoplasm in 1 patient, pseudocyst in 1 patient, and serous cystadenoma (SCA) in 1 patient. Follow-up CT in 3 patients (one each of MCN, SCA, and pseudocyst) after the initial diagnosis of cyst resolution was not available. For the remaining 9 patients (75%), follow-up CT performed in a median of 26 months (range 13-39 months) after initial documentation of cyst resolution demonstrated no evidence of cyst recurrence in any patient.

LIMITATIONS:

Loss to follow-up of some of the cohort.

CONCLUSIONS:

Follow-up after successful EUS-guided ethanol ablation of pancreatic cysts, including suspected mucinous cysts, suggests a durable, image-defined resolution. Longer follow-up in these patients is needed before considering these patients "cured" of their disease.

• Authors: John DeWitt, Christopher J DiMaio, William R Brugge
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 72 Issue 4 Pg. 862-6 (Oct 2010) ISSN: 1097-6779 [Electronic] United States
• PMID: 20883866 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Chemical References

• Carcinoembryonic Antigen
• Ethanol

Topics

• Carcinoembryonic Antigen (analysis)
• Catheter Ablation (methods)
• Endosonography
• Ethanol (administration & dosage)
• Follow-Up Studies
• Humans
• Pancreatic Cyst (diagnostic imaging, therapy)
• Recurrence
• Therapeutic Irrigation
• Tomography, X-Ray Computed
• Treatment Outcome