Reply to Jürgensen et al.

We were pleased to read the letter by Jürgensen et al. regarding our report on a single case of pancreatic endocrine tumor treated by ultrasound-guided ethanol injection. Their remarks give us the opportunity to clarify some aspects of our report.

Firstly, the ethanol injection was performed under ultrasound guidance using the same technique as for fine-needle aspiration; the percutaneous route was not followed. We are sorry that our incorrect abbreviation (i. e., “PEI”) led to confusion about our approach. On the other hand, we have already described the technique we used in the treatment of a pancreatic cyst [1].

Additionally, the main reason for our choice of treatment was the patient’s refusal to undergo surgery, which is undoubtedly the first option for pancreatic tumors. Our choice was further encouraged by the small size of the neoplasm (less than 13 mm). Both the concentration and the amount of ethanol did not exceed the recommendations of Matthes et al. [2], and we believe that alcohol diffusion during needle retraction was the cause of the complication we observed.

In conclusion, we appreciate the remarks of Jürgensen et al., which strongly stimulated our interest and led us to reflect that every novel technique requires the accurate analysis of several details, and that after early experiences corrections may be needed before the development of specific guidelines aimed at progressively improving therapeutic outcomes as well as preventing complications.

Competing interests: None

References

• 1 Muscatiello N, Pietrini L, Gentile M. et al . Endoscopic ultrasound-guided ethanol lavage of a pancreatic fluid collection.  Endoscopy. 2006;  38 951
• 2 Matthes K, Mino-Kenudson M, MD , Sahani D V. et al . Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection.  Gastrointest Endosc. 2007;  65 272-277