High-risk main-duct intraductal papillary mucinous neoplasm successfully treated with EUS-guided chemoablation.
High-risk main-duct intraductal papillary mucinous neoplasm successfully treated with EUS-guided chemoablation.
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DOI：
10.1016/j.vgie.2020.07.022
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Moyer MT
中科院分区：
文献类型：
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作者：
Hartz KM;Dixon MEB;Levenick J;Moyer MT
胰腺癌是最致命的恶性肿瘤之一，并且至少20%的这些癌症源于粘液型胰腺囊肿的进展。1，2直到最近，治疗胰腺黏液囊肿的唯一被广泛接受的选择是不确定的影像学监测或侵入性手术切除，两者都有明显的局限性。3，4，5 EUS引导化学消融是一种快速发展的技术，在适当选择的患者中，完全消融率为50%至79%。3，6，7，8具有高危特征的主导管导管内乳头状粘液性肿瘤（IPMN）已被排除在迄今为止的大多数消融试验之外，在文献检索中也没有发现关于主导管消融的报告。一名67岁男性心力衰竭患者到我们的机构评估胰腺囊性肿块病变。EUS-FNA显示高危特征，细胞病理学结果与IPMN一致。增强CT扫描显示主胰管扩张，如视频1所示。VideoGIE。org; and Fig. 1）.考虑到患者的心血管病史，认为其为高风险手术候选人。由于无酒精EUS引导化学消融术在我们机构的成功和安全性，考虑了这种选择。
Pancreatic cancer is one of the most lethal malignancies, and at least 20% of these cancers stem from progression of mucinous-type pancreatic cysts. 1, 2 Until recently, the only widely accepted options for managing mucinous pancreatic cysts were indefinite radiographic surveillance or invasive surgical resection, both with significant limitations. 3, 4, 5 EUS-guided chemoablation is a rapidly evolving technique, allowing 50% to 79% rates of complete ablation in appropriately selected patients. 3, 6, 7, 8 Main duct intraductal papillary mucinous neoplasms (IPMNs) with high-risk features have been excluded from most ablation trials to date, and no reports of main-duct ablation can be found in a literature search.A 67-year-old man with heart failure presented to our facility for assessment of a cystic mass lesion in the pancreas. EUS-FNA showed high-risk features, and cytopathology results were consistent with IPMN. Enhanced CT scan showed dilation of the main pancreatic duct as seen in Video 1 (available online at www. VideoGIE. org; and Fig. 1). The patient was considered a high-risk surgical candidate given his cardiovascular history. Because of the success and safety of alcohol-free EUS-guided chemoablation at our institution, this option was considered.