EUS-Guided Ethanol Injection for Treatment of Pancreatic Cancer

Objective: To evaluate the safety and efficacy of performing endosonography-guided cancer mass direct injection (EUS CPN) in patients with pancreatic cancer.

Patients and Methods: This group included 30 patients with pancreatic carcinoma. Using the linear array ultrasound endoscope (Pentax 3630U) and a eus-catheter needle (EUSN-20-CPN, Wilson-Cook), transgastroenteric injection of the pancreatic mass with dehydrated absolute alcohol was accomplished, after no indication of operation for advanced pancreatic cancer.

Results: 18 were localized in pancreatic head and 12 in the junction of body with tail. The mean age 56.63±13.23, mean diameter of tumor 39.78mm±18.53mm, mean ethanol amount 25.59±4.32ml. The mean CEA level was 458.07±2.99 U/mL. 20 patients with cancer pain performed endosonography-guided celiac plexus neurolysis (EUS CPN) at the same time as mass injected. Prior to injection pain scores 6.12±2.35. After injection following up 2–7m, cancer mass was reduced, 5/30 cases decreased for over 70% and 17/30 ones for 50% in volume of tumor after 3–4 times alcoholic treatment. Cancer pain score was decreased to mean 2.43±1.12 and with small or little amount of narcotic using. Complications: All patients had no acute pancreatitis and mean serum amylase was 76.21±9.62 U/ml in 24hr. 2 example suffered from the orthostasis, and in 6 hours to alleviate. Ten patients were observed mild bleeding at the site of injection. Two patients had transient diarrhea lasting less than 48 hours. All cases have no the infection and perforation occurrence.

Conclusions: EUS may localize and inject the mass accurately. EUS-guided cancer mass injecting and CPN are safe and effective means for improving pancreatic cancer prognosis and pain control in patients with pancreatic cancer.

Keywords Endoscopic ultrasound; pancreatic cancer; Ethanol