scholarly journals Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions

2016 ◽  
Vol 65 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Hafiz Muhammad Sharjeel Arshad ◽  
Sheila Bharmal ◽  
Deniz Guney Duman ◽  
Suthat Liangpunsakul ◽  
Brian G Turner
Keyword(s):  
Endoscopic Ultrasound ◽  
Mucinous Cystadenoma ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Ethanol Ablation ◽  
Drug Eluting Beads ◽  
Drug Eluting ◽  
Management Techniques ◽  
Management Approaches

Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk.

scholarly journals Impact of Antibiotic Prophylaxis on Infection Rate after Endoscopic Ultrasound Through-the-Needle Biopsy of Pancreatic Cysts: A Propensity Score-Matched Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 211
Author(s):  
Antonio Facciorusso ◽  
Martha Arevalo-Mora ◽  
Maria Cristina Conti Bellocchi ◽  
Laura Bernardoni ◽  
Daryl Ramai ◽  
...  
Keyword(s):  
Adverse Event ◽  
Propensity Score ◽  
Antibiotic Prophylaxis ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Mucinous Cystadenoma ◽  
Adverse Event Rate ◽  
Pancreatic Cysts ◽  
Control Group ◽  
Cystic Lesions

Background: Despite weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) of pancreatic cystic lesions (PCLs) is routinely used in clinical practice. We aim to compare a group of patients treated with antibiotics before EUS-TTNB of PCLs and a group who did not undergo antimicrobial prophylaxis. Methods: Out of 236 patients with pancreatic cystic lesions referred to two high-volume centers between 2016 and 2021, after propensity score matching, two groups were compared: 98 subjects who underwent EUS-TTNB under antibiotic prophylaxis and 49 subjects without prophylaxis. Results: There was no difference in terms of baseline parameters between groups. Final diagnosis was serous cystadenoma in 36.7% of patients in the group not treated with prophylaxis and in 37.7% of patients in the control group, whereas IPMN and mucinous cystadenoma were diagnosed in 3 (6.1%) and 16 (32.6%) versus 6 (6.1%) and 32 (32.6%) patients in the two groups, respectively (p = 0.23). Overall, the adverse event rate was 6.1% in the group not treated with antibiotic prophylaxis and 5.1% in the control group (p = 0.49). Only a single infectious adverse event occurred in each group (p = 0.48). The diagnostic yields were 89.7% and 90.8% in the two groups (p = 0.7), and the diagnostic accuracy rate was 81.6% in both groups (p = 1.0). Conclusions: Prophylactic antibiotics do not seem to influence the risk of infection, and their routine use should be discouraged.

Mucinous Cystic Neoplasms of the Pancreas: How Much Preoperative Evaluation is Needed?

2010 ◽  
Vol 76 (8) ◽  
pp. 812-817 ◽  
Author(s):  
Tom P. Theruvath ◽  
Katherine A. Morgan ◽  
David B. Adams
Keyword(s):  
Operative Treatment ◽  
Endoscopic Ultrasound ◽  
Preoperative Evaluation ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Cystic Lesions ◽  
Mri Imaging ◽  
Diagnostic Dilemma ◽  
Cystic Neoplasms ◽  
Preoperative Workup

Cystic lesions of the pancreas are identified with increasing frequency by modern imaging. The mucinous cystic neoplasm (MCN) is treated with resection for its malignant potential. How much preoperative evaluation is needed before undertaking operation is frequently a diagnostic dilemma. A retrospective review of 32 patients who underwent resection of a MCN between 1994 and 2007 was performed to define the preoperative evaluation and operative treatment of MCN patients. Thirty-two patients (30 women; mean age 49) had histology-proven MCN. Twenty-seven patients had symptomatic cysts (84%). Five had a history of gallstones and/or acute pancreatitis. All patients were worked up with CT and/or MRI. Endoscopic ultrasound was performed in 14 (44%) and endoscopic retrograde cholangiopancreatography in six (18%). Cytology was obtained in 13 (40%). Pathology revealed 22 benign MCNs (68%), five malignant MCNs (16%), and five MCNs with borderline pathology. Preoperative workup including CT or MRI imaging and cytology suggested MCN as the lesion in 15 patients (46%). CT features by itself predicted MCN in three patients (9%). Cytology revealed another six patients (19%) with possible MCN. In this series, preoperative workup did not identify three of five patients with MCN malignancy. A preoperative diagnosis cannot be made in most patients with MCN. Operative treatment can be based on clinical presentation and CT imaging because endoscopic ultrasound and fine needle aspiration for evaluation may be misleading. Middle-aged women with cystic lesions in the tail of the pancreas without prior gallstone or pancreatitis history most typically fit the profile of the MCN patient.

scholarly journals Cystic lesions of pancreas: challenges in diagnosis and management

2016 ◽  
Vol 18 (3) ◽  
pp. 53
Author(s):  
S Bohara ◽  
TY Tamang ◽  
DK Maharjan ◽  
SK Shrestha ◽  
PB Thapa
Keyword(s):  
Cystic Lesion ◽  
Mucinous Cystadenoma ◽  
Pancreatic Head ◽  
College Teaching ◽  
Serous Cystadenoma ◽  
Pancreatic Tumors ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Pancreatic Cystic Lesion ◽  
First Case

Introduction: Pancreatic cysts are common (2.5%). Cystic neoplasms represent 10% of cystic lesions and 1% of pancreatic tumors. However, it is difficult to differentiate benign cyst from malignant cystic lesions preoperatively.Objective: To study the cases of pancreatic cystic lesion who underwent various forms of pancreatic resection.Materials and Methods: Nine cases of pancreatic cystic lesion who presented to Kathmandu Medical College Teaching Hospital, Surgical Unit 3 within December 2014- November 2015 were evaluated. Four pancreatic cysts who underwent resection are discussed whereas not managed with resection are excluded.Results: There were 4 cases of pancreatic cyst who underwent pancreatic resection. First case underwent pancreaticoduodenectomy for pancreatic mucinous cystadenoma. However histopathological examination revealed a serous cystadenoma. In second case, pancreatic neck lesion suspected to be mucinous cystadenoma or pseudocyst in MRCP, with negative malignant cells in EUS guided FNAC underwent Central pancreatectomy and was found to be serous cystadenoma. The third case with suspected pseudocyst underwent Pancreaticoduodenectomy after a 3X2 cm2 cystic mass was felt at the posteroinferior side of pancreatic head and malignancy was suspected intraoperatively . HPE report was mucinous cystadenoma. The fourth case with pancreatic pseudocyst at tail with duct calculi and chronic pancreatitis underwent distal pancreatectomy with splenectomy with Frey’s procedure.Conclusion: Management of pancreatic cystic lesion is challenging. Though radiological imaging has limited role in accurate diagnosis, endoscopic ultrasound may be of some benefit.

scholarly journals The Role of Confocal Endomicroscopy in the Diagnosis and Management of Pancreatic Cysts

2021 ◽  
pp. 41-49
Author(s):  
Margaret G Keane ◽  
Stephen P Pereira
Keyword(s):  
Diagnostic Accuracy ◽  
Needle Aspiration ◽  
Diagnostic Techniques ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Common Clinical Finding

Pancreatic cystic lesions are an increasingly common clinical finding. Current diagnostic techniques cannot reliably differentiate patients with high-risk lesions requiring surgical resection from those that can be safely surveyed or discharged. As a result, some patients may undergo unnecessary surgery with associated morbidity while others enter long-term surveillance with associated healthcare costs. Needle-based confocal laser endomicroscopy enables real time microscopic examination of the epithelial lining of a cyst wall at the time of a standard endoscopic ultrasound examination. The procedure is associated with low rates of adverse events, especially when the probe is loaded into the fine-needle aspiration needle before the procedure and examination times are limited. Needle-based confocal laser endomicroscopy has consistently been shown to have better diagnostic accuracy than cytology, which is often paucicellular and non-diagnostic in pancreatic cystic lesions. Studies have shown that diagnostic accuracy in needle-based confocal laser endomicroscopy is 84–95% in mucinous lesions and 39–99% in serous lesions. However, this technology is expensive and its place in diagnostic algorithms remains uncertain. Despite this, health economic analyses in certain health systems have been favourable, largely because of its potential to be able to discharge patients with benign lesions, such as serous cystic neoplasms, from long-term surveillance. Widespread adoption of this technology is unlikely but it has the potential to have an important role in indeterminate pancreatic cystic lesions.

scholarly journals Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation

2019 ◽  
Vol 144 (1) ◽  
pp. 47-61 ◽  
Author(s):  
Amrou Abdelkader ◽  
Bryan Hunt ◽  
Christopher P. Hartley ◽  
Nicole C. Panarelli ◽  
Tamara Giorgadze
Keyword(s):  
Cyst Fluid ◽  
Integrative Approach ◽  
Cystic Degeneration ◽  
Pancreatic Cysts ◽  
Molecular Characteristics ◽  
Molecular Testing ◽  
Team Approach ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Fluid Analysis

Context.— Pancreatic cystic lesions (PCLs) are very common, and their detection is increasing with the advances in imaging techniques. Because of the major implications for management, distinguishing between neoplastic and nonneoplastic PCLs is critical. Neoplastic cysts with potential to progress into cancer include mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) and nonmucinous cysts (solid pseudopapillary tumors, serous cystic neoplasms, and neuroendocrine tumors with cystic degeneration). Nonneoplastic cysts with no risk of malignant transformation include pseudocysts, retention cysts, lymphoepithelial cysts, cystic pancreatic lymphangioma, and duplication cyst/ciliated foregut cysts. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology with cyst fluid analysis in the diagnosis of PCLs has evolved during the last decade; however, a definitive diagnosis on cytologic specimens is hampered by the sparse cellularity and can be challenging. EUS-FNA can play an important role to differentiate low-risk from high-risk pancreatic cysts and to distinguish between patients with cysts who need clinical follow-up versus those who require surgery. Objective.— To provide an integrative approach to diagnose pancreatic cystic lesions using EUS-FNA cytology and cyst fluid analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics. Data Sources.— The review and analysis of the latest literature describing pancreatic cystic lesions. Conclusions.— Accurate diagnosis of PCLs requires a multidisciplinary and multimodal team approach, including the integration of clinical findings, imaging, cytology, cyst fluid analysis, and molecular testing.

Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: A meta-analysis and systematic review

2015 ◽  
Vol 34 (3) ◽  
pp. 193-199 ◽  
Author(s):  
Manasa Kandula ◽  
Harsha Moole ◽  
Michael Cashman ◽  
Fritz H. Volmar ◽  
Matthew L. Bechtold ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Ultrasound ◽  
Meta Analysis ◽  
Pancreatic Cysts ◽  
Ultrasound Guided ◽  
Ethanol Ablation

scholarly journals Clinical outcomes of endoscopic ultrasound-guided ethanol ablation for pancreatic cystic lesions compared with the natural course: a propensity score matching analysis

2018 ◽  
Vol 11 ◽  
pp. 175628481875992 ◽  
Author(s):  
Jin Ho Choi ◽  
Sang Hyub Lee ◽  
Young Hoon Choi ◽  
Jinwoo Kang ◽  
Woo Hyun Paik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Endoscopic Ultrasound ◽  
Cystic Lesions ◽  
Ultrasound Guided ◽  
Resection Rate ◽  
Ethanol Ablation ◽  
Clinical Benefits

Background Endoscopic ultrasound-guided ethanol ablation (EUS-EA) is a recently introduced treatment for pancreatic cystic lesions (PCLs). However, clinical benefits such as survival gain and maintenance of quality of life (QOL) have not been fully established. The aim of this study was to evaluate the clinical benefits of EUS-EA compared with the natural course (NC) of PCLs. Methods This retrospective comparative study of patients with PCLs investigated an EUS-EA group ( n = 118) and an NC group ( n = 428). Propensity score matching (PSM) analysis was applied to minimize the effects of selection bias. The overall survival as the primary outcome and the surgical resection rate and complete remission (CR) rate as the secondary outcomes were evaluated. Results Between 84 matched pairs of both groups, there were no significant differences in the baseline clinical characteristics and the mean follow-up duration (78.88 ± 38.86, 75.90 ± 57.46 months, p = 0.694). Overall survival did not differ significantly (194.12 ± 5.60, 247.54 ± 12.70 months, p = 0.235). The surgical resection rate (4.8% versus 26.2%, p < 0.001) was significantly lower in the EUS-EA group. CR was observed only in the EUS-EA group and the CR rate was 32.1%. Conclusions EUS-EA for PCLs with low risk of malignancy might not be able to obtain a survival benefit, but showed maintenance of QOL by avoidance of unnecessary surgery, and a certain level of CR when compared to the NC. EUS-EA could be considered a useful treatment option for these, but careful application is needed because of the limited effects in some types of PCLs.

Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts

Endoscopy ◽  
2017 ◽  
Vol 49 (09) ◽  
pp. 866-873 ◽  
Author(s):  
Jun-Ho Choi ◽  
Dong Seo ◽  
Tae Song ◽  
Do Park ◽  
Sang Lee ◽  
...  
Keyword(s):  
Treatment Response ◽  
Endoscopic Ultrasound ◽  
Complete Resolution ◽  
Pancreatic Cysts ◽  
Long Term Outcomes ◽  
Cyst Size ◽  
Cystic Neoplasms ◽  
Partial Resolution

Abstract Background and study aims The aim of this study was to investigate the long-term outcomes after endoscopic ultrasound (EUS)-guided pancreatic cyst ablation. Patients and methods In a single-center, prospective study, 164 patients with pancreatic cysts underwent EUS-guided cyst ablation using ethanol with paclitaxel. The inclusion criteria were as follows: unilocular or oligolocular cysts; clinically indeterminate cysts that required EUS fine-needle aspiration; and/or cysts that grew during the observation period. Treatment response was classified as complete resolution, partial resolution, or persistent cyst, with < 5 %, 5 % – 25 %, and 25 % of the original cyst volume, respectively. Results The median largest diameter of the cyst was 32 mm and the median volume was 17.1 mL. Based on cyst fluid analysis there were 71 mucinous cystic neoplasms, 16 serous cystic neoplasms, 11 intraductal papillary mucinous neoplasms, 3 pseudocysts, and 63 indeterminate cysts. Sixteen treated patients (9.8 %) had adverse events (1 severe, 4 moderate, and 11 mild). Treatment response was as follows: complete resolution in 114 (72.2 %), partial resolution in 31 (19.6 %), and persistent cysts in 13 (8.2 %). Twelve of the 13 patients with persistent cysts underwent surgery. During clinical and imaging follow-up (median 72 months, interquartile range 50 – 85 months) of the 114 patients with complete resolution, only two patients (1.7 %) showed cyst recurrence. Based on multivariate analysis, the absence of septa (odds ratio [OR] 7.12, 95 % confidence interval [CI] 2.72 – 18.67) and cyst size less than 35 mm (OR 2.39, 95 %CI 1.11 – 5.16) predicted complete resolution. Conclusion Among patients with pancreatic cysts in whom complete resolution was achieved after EUS-guided cyst ablation, 98.3 % remained in remission at 6-year follow-up. Unilocular form and small cyst size were predictive of complete resolution. This treatment approach may be an effective and durable alternative to surgery.Trial registered at ClinicalTrials.gov (NCT 00689715).

scholarly journals Diagnosis and management of pancreatic cystic neoplasms

2019 ◽  
Vol 10 (3) ◽  
pp. 300-308 ◽  
Author(s):  
Mathew James Keegan ◽  
Bharat Paranandi
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Guidelines ◽  
Clinicopathological Features ◽  
Evidence Based ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Current Classification ◽  
Pancreatic Cystic Neoplasms

This review outlines the current classification of pancreatic cystic lesions, with a particular emphasis on pancreatic cystic neoplasms (PCNs). It will describe the diagnostic approach to PCNs, with reference to clinicopathological features, cross-sectional radiology and endoscopic ultrasound. This review will conclude with an evidence-based discussion of the management of PCNs focused on recent clinical guidelines.

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