Endoscopic ultrasound-guided ethanol ablation therapy for tumors

Abstract

Endoscopic ultrasonography (EUS) has evolved into a useful therapeutic tool for treating a broad range of tumors since being introduced into clinical practice as a diagnostic modality nearly three decades ago. In particular, EUS-guided fine-needle injection has proven a successful minimally invasive approach for treating benign lesions such as pancreatic cysts, relieving pancreatic pain through celiac plexus neurolysis, and controlling local tumor growth of unresectable malignancies by direct delivery of anti-tumor agents. One such ablative agent, ethanol, is capable of safely ablating solid or cystic lesions in hepatic tissues via percutaneous injection. Recent research and clinical interest has focused on the promise of EUS-guided ethanol ablation as a safe and effective method for treating pancreatic tumor patients with small lesions or who are poor operative candidates. Although it is not likely to replace radical resection of localized lesions or systemic treatment of metastatic tumors in all patients, EUS-guided ablation is an ideal method for patients who refuse or are not eligible for surgery. Moreover, this treatment modality may play an active role in the development of future pancreatic tumor treatments. This article reviews the most recent clinical applications of EUS-guided ethanol ablation in humans for treating pancreatic cystic tumors, pancreatic neuroendocrine tumors, and metastatic lesions.

Keywords: Endoscopic ultrasonography; Ethanol; Tumor ablation; Pancreas cancer; Cystic tumor; Neuroendocrine tumors; Celiac plexus neurolysis

Core tip: Ethanol, a commonly used ablative agent, has been used to successfully and safely ablate solid and cystic hepatic lesions via percutaneous injection. Endoscopic ultrasonography (EUS)-guided ethanol ablation, a minimally invasive approach, was recently developed and has been successfully applied as treatment of pancreatic cysts, pancreatic neuroendocrine tumors, and abdominal metastatic lesions. Although it is not likely to replace radical resection for treating localized lesions or systemic therapy for managing metastatic tumors, EUS-guided ablation therapies represent an attractive alternative treatment modality for patients who refuse or are not eligible for surgery.