Alcohol-free EUS-guided chemoablation of multiple pancreatic insulinomas

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided chemoablation with ethanol lavage, followed by infusion with paclitaxel, has been found to be effective for treatment of mucinous pancreatic cysts. However, there are notable adverse events (AEs) associated with ethanol and its undesirable inflammatory effects on local tissue and vessels. The recent ChARM trial demonstrated that removing ethanol from the cyst ablation process resulted in equivalent efficacy while significantly reducing associated AEs. Encouraged by these results, we speculated that alcohol-free chemoablation can be applied to treatment of solid tumors, as described in our case with a patient with severe and symptomatic recurrent hypoglycemia in the setting of multifocal insulinomas. As a result, the patient saw a significant reduction in symptoms. EUS-guided alcohol-free chemoablation may represent a new alternative to previously established therapies that will ultimately reduce risk of AEs.

• References

• 1 Lawrence B, Gustafsson BI, Chan A. et al. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 2011; 40: 1
• 2 Hirshberg B, Cochran C, Skarulis M. et al. Malignant insulinoma. Cancer 2005; 104: 264-272
• 3 Mathur A. The Surgical clinics of North America: Insulinoma. WB Saunders Company; 2009 89. 1105
• 4 Moyer MT, Sharzehi S, Abraham M. et al. The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol. Gastroenterology 2017; 153: 1295-1303
• 5 Moyer MT, Dye CE, Sharzehi S. et al. Is alcohol required for effective pancreatic cyst ablation? The prospective randomized CHARM trial pilot study. Endosc Intl Open 2016; 4: E603-E607
• 6 Levy MJ, Thompson GB, Topazian MD. et al. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc 2012; 75: 200-206
• 7 Deprez PH, Claessens A, Borbath I. et al. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroenterol Belg 2008; 71: 333-337
• 8 DeWitt J, McGreevy K, Schmidt CM. et al. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc 2009; 70: 710-723
• 9 Oh HC, Seo DW, Lee TY. et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008; 67: 636-642