EUS-guided Treatment of Pancreas Cystic Tumors: Ethanol Lavage followed by Paclitaxol Injection

Background: EUS-guided ethanol lavage has been tried to ablate cystic lesions of the pancreas and proven to be feasible and safe modality. However, there seems to be a significant number of cystic lesions unresponsive to this type of treatment. This study was conducted to test the feasibility, safety and efficacy of EUS-guided ethanol lavage and paclitaxol injection for the treatment of pancreatic cystic tumors.

Material & Methods: Eleven patients (M:F=3:8) with pancreatic cystic lesions were enrolled. Under EUS-guidance, cystic lesion was punctured and cystic fluid was aspirated using 22G needle. Ethanol (80–100%) was injected into the cyst and injected ethanol was re-aspirated after 2–3 minute retention. Then paclitaxol was injected into the cystic cavity after dilution.

Results: The median age of included patients was 50yrs (range: 28–75yrs) and the median cyst size was 2.5cm (range: 1.4–5.4cm) in long diameter. Tentative diagnosis before treatment was mucinous cystadenoma (n=7), serous cystadenoma (n=3) and lymphangioma (n=1). During median follow-up of 172 days (range: 30–540 days), treatment response could be evaluated in 7 patients and all the patients showed improvement after treatment (100%): complete disappearance (n=5), or decreasing size (n=2). Treatment response could not be evaluated in remaining 4 patients due to a short follow-up period. Clinically significant pancreatitis was developed in one patient and transient elevation of serum amylase was observed in 3 patients. Vague abdominal discomfort was lasted for several months in one patient. All complications were managed effectively just by supportive measures.

Conclusions: EUS-guided ethanol lavage followed by paclitaxol injection seemed to be safe and feasible. Most of patients showed improvement after treatment with minimal complications. Further prospective studies are required to prove these observations.