Endoscopy
DOI: 10.1055/s-0043-117938
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Endoscopic ultrasonography-guided photodynamic therapy for recurrent intraductal papillary mucinous neoplasm of the pancreas

Sun-Ho Lee*, Hoonsub So*, Seungwhan Shin, Nah Kyum Lee, Do Hyun Park
  • Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
Further Information

Corresponding author

Do Hyun Park, MD, PhD
Division of Gastroenterology
Department of Internal Medicine
University of Ulsan College of Medicine
Asan Medical Center
88, Olympic-Ro 43-Gil
Songpa-Gu
Seoul 05505
Korea   
Fax: +82-2-4760824   

Publication History

Publication Date:
13 September 2017 (eFirst)

 

Recurrence rates after partial pancreatectomy in patients with a noninvasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas are reported as being 5.4 % to 10.7 % [1] [2] [3]. A recent case demonstrated the possibility of using photodynamic therapy (PDT) as an alternative therapeutic option for IPMN [4]. Herein, we present a patient who was treated with endoscopic ultrasonography (EUS)-guided PDT, which was used as an alternative, minimally invasive option for recurrent IPMN of the pancreas.

A 50-year-old man was admitted with recurrent pancreatitis. He had a history of distal pancreatectomy for combined-type IPMN 2 years previously, and the resection margins had been positive. A computed tomography (CT) scan revealed swelling of the remnant pancreas with a 13-mm hypodense lesion and prominent main pancreatic duct (MPD) dilatation. EUS-guided needle biopsy of a 5-mm nodular lesion in the MPD and a 15-mm hypoechoic mass in the stump demonstrated recurrent IPMN with low grade dysplasia ([Fig. 1]). The patient refused to undergo total pancreatectomy, so we decided to perform EUS-guided PDT ([Video 1]) [5].

Zoom Image
Fig. 1 Endoscopic ultrasonography (EUS) image showing: a a 5-mm nodular lesion in the main pancreatic duct; b a 15-mm hypoechoic mass in the stump.

Video 1 Endoscopic ultrasonography-guided photodynamic therapy for recurrent noninvasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas following a previous distal pancreatectomy.

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Photolon (a chlorin e6 derivative; Belmedpreparaty, Belarus) was administered at a dose of 2.5 mg/kg, 3 hours before the procedure. The flexible laser-light probe (a quartz core and polymer cladding; PhotoGlow Inc., Yarmouth, Massachusetts, USA) was preloaded inside a 19 G EUS fine needle aspiration (FNA) needle (Cook Endoscopy, Winston-Salem, North Carolina, USA) and was inserted into the recurrent tumor. The tumor was then illuminated with a wavelength of 660 nm ([Fig. 2 a]). The energy dose was 100 J/cm of the diffuser length; the power of irradiation was 400 mW/cm of the diffuser length in each procedure. The total irradiation time in each needle pass was 250 seconds.

Zoom Image
Fig. 2 Endoscopic ultrasonography (EUS) images showing: a a hyperechoic cloud in the area surrounding the laser diffuser tip during EUS-guided photodynamic therapy (PDT); b no evidence of tumor recurrence 2 years after the PDT.

At follow-up EUS 2 years after the PDT, there was no evidence of recurrence ([Fig. 2 b]). EUS-guided biopsy at the pancreas stump showed only acinar cells and interstitial fibrosis. The patient experienced no further episodes of pancreatitis during the follow-up period.

This study was approved by the Institutional Review Board of Asan Medical Center (IRB number: 2015-0111).

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Competing interests

None

* Contributed equally to this article



Corresponding author

Do Hyun Park, MD, PhD
Division of Gastroenterology
Department of Internal Medicine
University of Ulsan College of Medicine
Asan Medical Center
88, Olympic-Ro 43-Gil
Songpa-Gu
Seoul 05505
Korea   
Fax: +82-2-4760824   


Zoom Image
Fig. 1 Endoscopic ultrasonography (EUS) image showing: a a 5-mm nodular lesion in the main pancreatic duct; b a 15-mm hypoechoic mass in the stump.
Zoom Image
Fig. 2 Endoscopic ultrasonography (EUS) images showing: a a hyperechoic cloud in the area surrounding the laser diffuser tip during EUS-guided photodynamic therapy (PDT); b no evidence of tumor recurrence 2 years after the PDT.