Endoscopic ultrasound-guided ethanol ablation of a large metastatic carcinoid tumor: success with a note of caution.

Abstract

Endoscopic ultrasonography with fine needle infusion (EUS-FNI) of alcohol is the most reported method for EUS-guided tumor ablation. Several studies have reported successful EUS-guided ablation of pancreatic neuroendocrine tumors. However, these tumors have been relatively small (< 3 cm). In this report, a 50-year-old man with a metastatic carcinoid tumor with a large porta hepatis mass was referred to our clinic for EUS-guided ethanol ablation. After two separate EUS-FNI ablations, there was a 36 % reduction in tumor size (9.0 × 11.4 cm to 6.7 × 9.8 cm) with associated tumor lysis syndrome. Chromogranin A levels decreased from 460 to 132 ng/mL. The patient reported complete resolution of abdominal pain within 2 weeks, but only mild improvement in flushing and diarrhea. In conclusion, large metastatic neuroendocrine tumors can be successfully treated with EUS-guided ethanol ablation. Evidence-based guidelines are needed with regard to the appropriate volume of ethanol injected in EUS-guided ablation to promote the efficacy and safety of this emerging procedure.

• Authors: Bradley W Mathers, Harold A Harvey, Charles E Dye, Brandy Dougherty-Hamod, Matthew T Moyer
• Journal: Endoscopy international open (Endosc Int Open) Vol. 2 Issue 4 Pg. E256-8 (Dec 2014) ISSN: 2364-3722 [Print] Germany
• PMID: 26135103 (Publication Type: Case Reports)