EUS-Guided Pancreatic Cyst Ablation: a Clinical and Technical Review.
EUS-Guided Pancreatic Cyst Ablation: a Clinical and Technical Review.
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DOI：
10.1007/s11894-019-0686-5
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发表时间：
2019-04-23
影响因子：
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通讯作者：
DeWitt, John M
中科院分区：
文献类型：
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作者：
Moyer, Matthew T;Maranki, Jennifer L;DeWitt, John M
审查目的：胰腺囊性病变代表了一个日益增长的公共卫生困境，特别是随着我们的人口老龄化和横断面成像变得更加敏感。粘液囊肿具有临床显著的胰腺癌风险，预后极差。确定哪些囊肿会发展成癌症可能具有挑战性，并且胰腺的手术切除具有显著的发病率。本文的目的是回顾囊肿消融的基本原理，并讨论囊肿消融技术和疗效的既往和当前研究。适应症，禁忌症，最佳患者选择相关的因素outlined.Recent发现：内镜超声引导下化学消融胰腺囊肿已进行肿瘤性囊肿，不同程度的疗效。由于基于酒精的治疗存在胰腺炎风险，因此出现了安全性问题;然而，使用非酒精化学消融鸡尾酒的最新数据表明，消融术在不需要酒精的情况下是有效的，从而导致明显更有利的不良事件特征。内镜超声引导化学消融治疗胰腺肿瘤性囊肿是一种有前途的微创囊肿治疗方法，最近在安全性和有效性方面取得了重大进展，这表明它应该在治疗算法中发挥作用。
PURPOSE OF REVIEW: Pancreatic cystic lesions represent a growing public health dilemma, particularly as our population ages and cross-sectional imaging becomes more sensitive. Mucinous cysts carry a clinically significant risk of developing pancreatic cancer, which carries an extremely poor prognosis. Determining which cysts will develop cancer may be challenging, and surgical resection of the pancreas carries significant morbidity. The goal of this paper is to review the rationale for cyst ablation and discuss prior and current research on cyst ablation techniques and efficacy. Indications, contraindications, and factors related to optimal patient selection are outlined.RECENT FINDINGS: Endoscopic ultrasound-guided chemoablation of pancreatic cysts has been performed in neoplastic cysts, with varying levels of efficacy. Safety concerns arose due to the risk of pancreatitis in alcohol-based treatments; however, the most recent data using a non-alcohol chemoablation cocktail suggests that ablation is effective without the need for alcohol, resulting in a significantly more favorable adverse event profile. Endoscopic ultrasound-guided chemoablation of neoplastic pancreatic cysts is a promising, minimally invasive approach for treatment of cysts, with recent significant advances in safety and efficacy, suggesting that it should play a role in the treatment algorithm.