Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms

Table 1 Different injective ablative treatment methods

Agent	Concentration	Infusing method	Injected volume	Agent left
Ethanol	80%-100%, mainly 80%-99%	Single agent	50%, 90%, or 100% of the fluid extracted from the cyst	No ethanol
Ethanol + paclitaxe	Ethanol: 99%; paclitaxel: 2 mg/mL, 3 mg/mL, or 6 mg/mL	Paclitaxe was injected after the full aspiration of ethanol	Equal to the volume of cyst fluid aspirated	All paclitaxel
Lauromacrogol	10 mg/mL	Single agent	Ensuring the cystic wall completely soaked in solution	Mainly 2-10 mL lauromacrogol
Paclitaxel + gemcitabine	Paclitaxel: 3 mg/mL; gemcitabine: 19 mg/mL	Mixed to make a paclitaxel-gemcitabine cocktail	Equal to the original amount aspirated and the upper limit is 8 mL	All cocktail

Table 2 Studies of EUS-guided ablation using different agents

Ref.	Year	No. of patients	Ablative agent	Mean/median diameter (mm)	Diagnosis, n (%)				Follow-up (mo)	Treatment effectiveness, n (%)		No. of complications, n (%)
					SCN	MCN	IPMN	Others		CR	PR
Gan et al[14]	2005	25	5%-80% ethanol	19.4	3 (12)	13 (52)	4 (16)	5 (20)	12	8 (34.8)	2 (8.7)	0
DeWitt et al[35]	2009	42	80% ethanol vs saline	22.4	5 (11.9)	17 (40.5)	17 (40.5)	3 (7.1)	3-4 mo after second lavage	12 (33.3)	NA	12 (28.6): 10 (abdominal pain), 1 (intracys-tic hemorrhage), 1 (pancreatitis)
DiMaio et al[32]	2011	13	80% ethanol	20.1	0	0	13 (100)	0	3-6 mo after second lavage	5 (38.4)	NA	1 (7.7): 1 (abdomin-al pain)
Caillol et al[33]	2012	13	99% ethanol	24	0	13 (100)	0	0	26	11 (84.6)	NA	0
Gómez et al[25]	2016	23	80% ethanol	27.5	0	4 (17.4)	19 (82.6)	0	40	2 (8.7)	NA	2 (8.8): 1 (abdominal pain), 1 (pancreatitis)
Park et al[16]	2016	91	99% ethanol	58	33 (36.3)	12 (13.2)	9 (9.9)	37 (40.6)	40	41 (45.1)	37 (40.7)	29 (31.9): 18 (abdominal pain), 8 (fever), 3 (pancreatitis)
Oh et al[5]	2008	14	99% ethanol + paclitaxel	25.5	3 (21.5)	2 (14)	NA	9 (64.5)	9	11 (78.6)	2 (14.3)	8 (57.1): 1 (pancreatitis), 1 (abdominal pain), 6 (hyperamylasemia)
Oh et al[31]	2009	10	99% ethanol + paclitaxel	29.5	4 (40)	3 (30)	3 (30)	0	8.5	6 (60.0)	2 (20.0)	1 (10): 1 (pancreatitis)
Oh et al[15]	2011	52	99% ethanol + paclitaxel	31.8	15 (29)	9 (17)	NA	28 (54)	20	29 (61.7)	6 (12.8)	4 (7.7): 1 (pancreatitis), 1 (abdominal pain), 1 (fever), 1 (splenic vein obliteration)
Oh et al[28]	2014	10	99% ethanol + paclitaxel	39.5	NA	NA	NA	NA	12	NA	NA	7 (70): 5 (abdominal pain), 1 (vomiting), 1 (intracystic bleeding)
DeWitt et al[26]	2014	22	99% ethanol + paclitaxel	24	4 (18)	6 (27)	12 (55)	0	27	10 (50.0)	5 (25.0)	9 (40.1): 4 (abdomin-al pain), 3 (pancreatitis), 1 (peritonitis), 1 (gastric wall cyst)
Kim et al[27]	2017	36	100% ethanol or (ethanol + paclitaxel)	25.8	5 (13.9)	16 (44.4)	14 (38.9)	1 (2.8)	22.3	19 (55.9)	7 (19.4)	9 (25): 4 (pancreatitis), 4 (abdominal pain), 1 (intracystic hemorrhage)
Choi et al[29]	2017	164	99% ethanol + paclitaxel	32	16 (9.8)	71 (43.3)	11 (6.1)	66 (40.2)	72	114 (72.2)	31 (19.6)	15 (9.1): 6 (pancreatitis), 2 (pseudocyst), 2 (abscess), 1 (intracystic hemorrhage), 1 (pericystic spillage), 1 (pancreatic duct stricture), 1 (splenic vein obstruction), 1 (portal vein thrombosis)
Linghu et al[2]	2017	29	Lauromacrogol	28.6	12 (41.4)	15 (51.7)	0	2 (6.9)	9	11 (37.9)	9 (31.0)	3 (8.3): 2 (pancreatitis), 1 (fever)
Moyer et al[34]	2016	10	80% ethanol or Saline + paclitaxel and gemcitabine	29	0	7 (70%)	2 (20%)	1 (10%)	12	Ethanol free 4 (66.7) ethanol 3 (75.0)	NA	1 (10): 1 (pancreatitis)
Moyer et al[18]	2017	39	80% ethanol or saline + paclitaxel and gemcitabine	25	0	9 (23.1)	27 (69.2)	3 (7.7)	12	Ethanol free arm 14 (66.7) ethanol arm 11 (61.1)	NA	5 (12.8): 4 (abdominal pain), 1 (pancreatitis)

SCN: Serous cystic neoplasm; MCN: Mucinous cystic neoplasm; IPMN: Intraductal papillary neoplasm; CR: Complete response; PR: Partial complete; NA: Not available.