Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation

• Published in: Gastrointestinal endoscopy Vol. 72; no. 4; pp. 862 - 866
• Main Authors: DeWitt, John, MD, FASGE, FACG, DiMaio, Christopher J., MD, Brugge, William R., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.10.2010; Elsevier
• Subjects: Biological and medical sciences; Carcinoembryonic Antigen - analysis; Catheter Ablation - methods; Digestive system. Abdomen; Endoscopy; Endosonography; Ethanol - administration & dosage; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Pancreatic Cyst - diagnostic imaging; Pancreatic Cyst - therapy; Recurrence; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome; Tumors; SCA; mucinous cystic neoplasm; carcinoembryonic antigen; MCN; serous cystadenoma; IPMN; intraductal papillary mucinous neoplasm; CEA; Sonography; Pancreatic cyst; Ethanol; Endoscopic route; Endoscopic ultrasonography; Echography; Digestive diseases; Long term; Pancreatic disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.02.039

Background EUS-guided ablation of pancreatic cysts is a minimally invasive technique with reported short-term, CT-defined cyst resolution rates of 33% to 79%. Follow-up results of image-defined, successful pancreatic cyst ablation are not known. Objective To determine the durability of successful cyst resolution after EUS-guided ethanol lavage. Design Prospective cohort study. Setting Two tertiary-care referral hospitals in the United States. Patients This study involved 12 patients with 1-to-5-cm, unilocular, pancreatic cysts that had previously resolved after ethanol lavage. Interventions Follow-up CT after cyst resolution. Main Outcome Measurements The presence or absence of residual pancreatic cysts by CT scanning after previous successful ablation. Results In a previously reported trial, we found that CT scanning documented pancreatic cyst resolution in 12 patients (33%) after one (n = 6) or two (n = 6) ethanol lavages. These 12 cysts (median diameter 18 mm; range 10-34 mm) were located in the head/uncinate of the pancreas in 6 patients (50%) and in the body of the pancreas in 6 patients (50%). The median cyst fluid carcinoembryonic antigen (CEA) level (available in 11 patients) was 463 ng/mL (range 1.6-64,550 ng/mL; normal, 0-2.5 ng/mL). Clinical diagnoses were mucinous cystic neoplasm (MCN) in 9 patients, intraductal papillary mucinous neoplasm in 1 patient, pseudocyst in 1 patient, and serous cystadenoma (SCA) in 1 patient. Follow-up CT in 3 patients (one each of MCN, SCA, and pseudocyst) after the initial diagnosis of cyst resolution was not available. For the remaining 9 patients (75%), follow-up CT performed in a median of 26 months (range 13-39 months) after initial documentation of cyst resolution demonstrated no evidence of cyst recurrence in any patient. Limitations Loss to follow-up of some of the cohort. Conclusions Follow-up after successful EUS-guided ethanol ablation of pancreatic cysts, including suspected mucinous cysts, suggests a durable, image-defined resolution. Longer follow-up in these patients is needed before considering these patients “cured” of their disease.