Endoscopic Ultrasonography-Guided Ethanol Lavage With Paclitaxel Injection Treats Patients With Pancreatic Cysts
Endoscopic Ultrasonography-Guided Ethanol Lavage With Paclitaxel Injection Treats Patients With Pancreatic Cysts
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DOI：
10.1053/j.gastro.2010.10.001
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发表时间：
2011-01-01
期刊：
影响因子：
29.4
通讯作者：
Kim, Jihun
中科院分区：
文献类型：
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作者：
Oh, Hyoung-Chul;Seo, Dong Wan;Kim, Jihun
背景与目的：超声内窥镜(EUS)引导下的介入治疗已被用于治疗胰腺囊性病变(CLPs)。我们使用EUS引导注射和灌洗乙醇，然后注射紫杉醇到囊内，并研究治疗反应和预测因素。方法：52例患者纳入研究，纳入标准如下：单眼或少眼囊肿，需要EUS细针抽吸的不确定囊性病变，以及在观察期间生长的囊性病变。对47例患者进行了超过12个月的随访，并对结果进行了分析。结果：CLP直径17~68 mm，平均31.8 mm，体积估计为14.09 mL，1.16~68.74 mL。20个CLP为少晶状体。癌胚抗原平均水平为463 ng/m L(范围1-8190 ng/m L)。中位随访时间为21.7个月。完全缓解29例，部分缓解6例，持续性囊肿12例。12例持续性囊肿患者中有4例接受了手术治疗。上皮消融的组织病理学程度从0%到100%不等。在单因素分析中，EUS直径和原始体积预测囊性病变的分辨率；在多因素分析中，只有原始体积预测分辨率。轻度胰腺炎和脾静脉闭塞各1例。结论：EUS引导下注射和灌洗无水乙醇，然后注射紫杉醇，是治疗胰腺囊肿的一种安全的方法，62%的患者完全消退。小的囊腔体积预示着完全消退。
BACKGROUND & AIMS: Endoscopic ultrasonography (EUS)-guided interventions have been used to treat patients with cystic lesions of the pancreas (CLPs). We used EUS to guide injection and lavage of ethanol, followed by injection of paclitaxel, into cysts, and investigated treatment response and predictors. METHODS: Fifty-two patients were enrolled in the study using the following inclusion criteria: unilocular or oligolocular cysts, indeterminate cystic lesions that required EUS fine-needle aspiration, and cystic lesions that grew during the observation period. Forty-seven patients were followed up for more than 12 months and their outcomes were analyzed. RESULTS: The mean diameter of the CLPs was 31.8 mm (range, 17-68 mm) and the estimated volume was 14.09 mL (range, 1.16-68.74 mL). Twenty CLPs were oligolocular. The mean level of carcinoembryonic antigen was 463 ng/mL (range, 1-8190 ng/mL). The median follow-up period was 21.7 months. A complete response was observed in 29 patients, a partial response in 6 patients, and persistent cysts in 12 patients. Four of 12 patients with persistent cysts underwent surgery. The histopathologic degree of epithelial ablation varied from 0% to 100%. Based on univariate analysis, EUS diameter and original volume predicted cyst resolution; in multivariate analysis, only original volume predicted resolution. Mild pancreatitis and splenic vein obliteration each occurred in 1 patient. CONCLUSIONS: EUS-guided injection and lavage of ethanol, followed by injection of paclitaxel, appears to be a safe method for treating pancreatic cysts; 62% of patients had complete resolution. Small cyst volume predicted complete resolution.