scholarly journals Endoscopic Ultrasound-Guided Radiofrequency Ablation of the Pancreatic Tumors: A Promising Tool in Management of Pancreatic Tumors

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kinesh Changela ◽  
Rashmee Patil ◽  
Sushil Duddempudi ◽  
Vinaya Gaduputi
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Ultrasound ◽  
Pancreatic Neoplasms ◽  
Pancreatic Neoplasm ◽  
Case Series ◽  
Human Case ◽  
Pancreatic Tumors ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Novel Technique

Objective. Radiofrequency ablation is a well-established antitumor treatment and is recognized as one of the least invasive therapeutic modalities for pancreatic neoplasm. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) delivery can be used to treat both pancreatic cancer and asymptomatic premalignant pancreatic neoplasms and may serve as a less invasive alternative to surgical resection. This is an appealing option that may result in less morbidity and mortality. The aim of this review was to summarize and evaluate the clinical and technical effectiveness of EUS-guided RFA of pancreatic neoplasms.Methods. A through literature review was performed to identify the studies describing this novel technique. In this review article, we have summarized human case series. The indications, techniques, limitations, and complications reported are discussed.Results. A total of six studies were included. Overall, a 100% technical success rate was reported in human studies. Complications related to endoscopic ultrasound-guided radiofrequency ablation delivery have been described; however, few cases have presented life-threatening outcomes.Conclusion. We believe that this novel technique can be a safe and effective alternative approach in the management of selected patients.

scholarly journals Endoscopic Ultrasound-Guided Angiotherapy for Gastric Varices—A Small Retrospective Study

2020 ◽  
Vol 11 (03) ◽  
pp. 201-204
Author(s):  
Kapil Sharma ◽  
Mamta Sharma ◽  
Sanchit Singh
Keyword(s):  
Endoscopic Ultrasound ◽  
Case Series ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Limited Data ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Technical Success Rate ◽  
Complete Obliteration

Abstract Introduction Conventional n-butyl-cyanoacrylate (CYA) recommended for secondary prophylaxis of gastric varices (GV) is associated with significant rebleeding and glue embolism. Limited data are available on more successful and less risky endoscopic ultrasound-guided coils and CYA (EUS-Coils-CYA) injection in GV. Methods We present a retrospective case series of 12 patients with GV bleeding managed successfully with EUS-Coils-CYA injection leading to variceal eradication in 11 patients. Results From January 2018 to June 2019, 12 cases of GV, which were either bleeding or bled recently, were included. Complete obliteration was achieved in 91.6% of patients with 100% technical success. Mean number of deployed coils and volume of injected CYA glue were 1.16 and 1.58 mL, respectively. Conclusions EUS-guided angiotherapy is an effective and safe intervention for managing GV bleeding with high technical success rate.

Endoscopic ultrasound-guided radiofrequency ablation of pancreatic microcystic serous cystic neoplasms: a retrospective study

Endoscopy ◽  
2020 ◽  
Author(s):  
Dongwook Oh ◽  
Sung Woo Ko ◽  
Dong-Wan Seo ◽  
Seung-Mo Hong ◽  
Jin Hee Kim ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Ultrasound ◽  
Pancreatic Tumors ◽  
Ultrasound Guided ◽  
Cystic Neoplasms ◽  
Cystic Fluid ◽  
Median Volume ◽  
Long Term Follow Up ◽  
Serous Cystic Neoplasms

Abstract Background Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been increasingly used for the management of various solid pancreatic tumors. This study aimed to evaluate the feasibility and safety of EUS-RFA for serous cystic neoplasms (SCNs). Methods 13 patients with microcystic SCNs with honeycomb appearance underwent EUS-RFA using a 19-gauge RFA needle. Before ablation, cystic fluid was aspirated until a thin layer of fluid remained. Results EUS-RFA was successful in all patients. Seven patients underwent a single session and the remaining six patients underwent a second session of EUS-RFA. One patient (7.7 %) experienced self-limited abdominal pain after EUS-RFA. During a median follow-up period of 9.21 months (interquartile range [IQR] 5.93 – 15.38), the median volume of the SCNs decreased from 37.82 mL (IQR 15.03 – 59.53) at baseline to 10.95 mL (IQR 4.79 – 32.39) at the end of follow-up. A radiologic partial response was achieved in eight patients (61.5 %). Conclusions EUS-RFA is technically feasible and showed an acceptable rate of adverse events for patients with SCNs. A long-term follow-up study is required to evaluate the efficacy of EUS-RFA.

scholarly journals Endoscopic ultrasound-guided radiofrequency ablation of pancreatic neuroendocrine tumors: a case series

2020 ◽  
Vol 08 (12) ◽  
pp. E1754-E1758
Author(s):  
Germana de Nucci ◽  
Nicola Imperatore ◽  
Enzo Domenico Mandelli ◽  
Franca di Nuovo ◽  
Corrado d’Urbano ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Neuroendocrine Tumors ◽  
Endoscopic Ultrasound ◽  
Therapeutic Option ◽  
Case Series ◽  
Pancreatic Head ◽  
Complete Disappearance ◽  
Pancreatic Neuroendocrine Tumors ◽  
Ultrasound Guided ◽  
Effective Therapeutic Option

Abstract Background and study aims Surgery is the considered the therapeutic cornerstone for pancreatic neuroendocrine tumors (P-NETs), although burdened by high risk of significant adverse events. Recently, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been described for P-NETs. We aimed to evaluate the effectiveness and safety of EUS-RFA for treatment of P-NETs. Patients and methods We prospectively included all consecutive patients with P-NET ≤ 20 mm who were treated with EUS-RFA and were followed-up for at least 12 months. Results Ten patients (5 males, mean age 78.6 years, mean body mass index 28.2) with 11 P-NETs (mean size 14.5 mm; range 9 – 20 mm) localized in the pancreatic head (3 lesions), pancreatic body (5 lesions), and tail (3 lesions) underwent complete EUS ablation with one session of RFA. Complete ablation of P-NET was reached using a single-session RFA with a mean of 2.3 treatment applications per session. At both 6 – and 12-months computed tomography scans, all the patients had complete disappearance of lesions with radiological normalization. Regarding safety, only two cases of mild abdominal pain were recorded in two subjects with pancreatic head lesion, which were effectively treated with analgesics. The mean duration of hospital stay was 4 days (range 3 – 7 days). Conclusions EUS-RFA is effective and safe in treating P-NETs. It may be considered an effective therapeutic option in the treatment of small P-NETs independently from their functional status.

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

2020 ◽  
Author(s):  
Jing Li ◽  
Qian Zhang ◽  
Anni Zhou ◽  
Guiping Zhao ◽  
Wenhai Wang ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Medical Center ◽  
Meta Analysis ◽  
Case Series ◽  
Pancreatic Pseudocysts ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Walled Off Necrosis

Abstract Background and Aims: Endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and less injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different types of PFCs remains controversial, especially lumen-apposing mental stents (LAMS). This study aims to compare efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).Methods: A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.Results: Combining 11 searched literatures with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significant different from that of PPC (P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% versus 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). Further intervention of direct endoscopic necrosectomy was required in 60% of patients in WON group. There was no significant difference in the incidence of adverse events after LAMS placement between WON and PPC, including infection, bleeding, stent migration and stent occlusion.Conclusions: Endoscopic ultrasound-guided LAMS for PFCs is feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors

Endoscopy ◽  
2018 ◽  
Vol 50 (11) ◽  
pp. 1099-1104 ◽  
Author(s):  
Jun-Ho Choi ◽  
Dong-Wan Seo ◽  
Tae Song ◽  
Do Park ◽  
Sang Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Complete Response ◽  
Pancreatic Tumors ◽  
Clinical Settings ◽  
Ultrasound Guided ◽  
Effective Treatment Option ◽  
Remnant Tumor

Abstract Background Radiofrequency ablation (RFA) has been increasingly employed in experimental and clinical settings for the management of pancreatic lesions. This study aimed to assess the safety and efficacy of endoscopic ultrasound (EUS)-guided RFA for benign solid pancreatic tumors. Methods In a single-center, prospective study, 10 patients with benign solid pancreatic tumors underwent EUS-RFA. After the RFA electrode had been inserted into the pancreatic mass, the radiofrequency generator was activated to deliver 50 W of ablation power. Results Among the 10 patients, 16 sessions of EUS-RFA were successfully performed. Diagnoses included nonfunctioning neuroendocrine tumor (n = 7), solid pseudopapillary neoplasm (n = 2), and insulinoma (n = 1); the median largest diameter of the tumors was 20 mm (range 8 – 28 mm). During follow-up (median 13 months), radiologic complete response was achieved in seven patients. Two adverse events (12.4 %; 1 moderate and 1 mild) occurred. Conclusions EUS-RFA may be a safe and potentially effective treatment option in selected patients with benign solid pancreatic tumors. Multiple sessions may be required if there is a remnant tumor, and adverse events must be carefully monitored.

scholarly journals Endoscopic Ultrasound Guided Rendezvous Drainage of Biliary Obstruction Using a New Flexible 19-Gauge Fine Needle Aspiration Needle

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Zhouwen Tang ◽  
Efehi Igbinomwanhia ◽  
Sherif Elhanafi ◽  
Mohamed O. Othman
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Guide Wire ◽  
Case Series ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Technical Success Rate ◽  
Significant Difference

Background and Aim. A successful endoscopic ultrasound guided rendezvous (EUS-RV) biliary drainage is dependent on accurate puncture of the bile duct and precise guide wire manipulation across the ampulla of Vater. We aim to study the feasibility of using a flexible 19-gauge fine aspiration needle in the performance of EUS-RV biliary drainage. Method. This is a retrospective case series of EUS-RV biliary drainage procedures at a single center. Patients who failed ERCP during the same session for benign or malignant biliary obstruction underwent EUS-RV using a flexible, nitinol covered, 19-gauge needle for biliary access and guide wire manipulation. Result. 24 patients underwent EUS-RV biliary drainage via extrahepatic access while 1 attempt was via intrahepatic access. The technical success rate was 80%, including 83.3% of cases via extrahepatic access. There was no significant difference in success rate of inpatient and outpatient procedures, benign or malignant indications, or type of guide wire used. Adverse events included mild pancreatitis (3 patients) and cholangitis (1 patient). Conclusion. A flexible 19-gauge needle for biliary access can be safe and effective when used to perform EUS-RV biliary drainage. Direct comparison between the nitinol needle and conventional metal needles in the performance of EUS guided biliary drainage is needed.

scholarly journals Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S765
Author(s):  
J.H. Choi ◽  
D.W. Seo ◽  
T.J. Song ◽  
D.H. Park ◽  
S.S. Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Ultrasound ◽  
Pancreatic Tumors ◽  
Ultrasound Guided

scholarly journals Endoscopic ultrasound–guided luminal remodeling as a novel technique to restore gastroduodenal continuity

2020 ◽  
Vol 8 ◽  
pp. 2050313X2095004
Author(s):  
Hicham El Bacha ◽  
Carlo Jung ◽  
Bertrand Brieau ◽  
Benoit Bordacahar ◽  
Sarah Leblanc ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Surgical Procedure ◽  
Case Series ◽  
Metallic Stents ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Duodenal Injury ◽  
Retrospective Case ◽  
Novel Technique ◽  
Pyloric Exclusion

Pyloric exclusion is a method of treatment for duodenal injury. Surgery is usually needed to restore digestive continuity in due time, yet a new surgical procedure can be challenging due to fibrotic adhesion development. We present here a retrospective case series of three patients with pyloric exclusion who underwent endoscopic ultrasound–guided duodenal repermeabilization using metallic stents. All procedures were successful with no complication and allowed regular feeding. This case series shows that endoscopic ultrasound–guided recanalization is a feasible and safe procedure.

scholarly journals Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

2021 ◽  
Vol 14 ◽  
pp. 175628482110421
Author(s):  
Ghassan El Sayed ◽  
Levente Frim ◽  
Jamie Franklin ◽  
Raymond McCrudden ◽  
Charles Gordon ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Radiofrequency Ablation ◽  
Endoscopic Ultrasound ◽  
Case Reports ◽  
Case Series ◽  
Clinical Success Rate ◽  
Ablation Techniques ◽  
Neuroendocrine Neoplasm ◽  
Efficacy And Safety ◽  
Ultrasound Guided

Background: Insulinoma is the most common neuroendocrine neoplasm of the pancreas, characterised by hypoglycaemic symptoms. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and ethanol ablation (EUS-EA) are novel methods for treating insulinoma. We aimed to perform a systematic review to assess the efficacy and safety of EUS-guided ablation techniques for pancreatic insulinomas. Methods: We systematically searched for articles detailing EUS-guided ablations of insulinomas. We performed a qualitative analysis and summarised data on the efficacy and safety of EUS-RFA and EUS-EA techniques. Results: In total, we identified 35 case reports and case series describing 75 patients with insulinomas treatment with EUS-guided ablation. Twenty-seven patients were treated with EUS-RFA, 47 patients with EUS-EA, and 1 patient received EUS-EA and EUS-RFA in the same session. In total, 84 insulinomas were ablated (EUS-RFA: 31, EUS-EA: 53). Most insulinomas were in the head of the pancreas (40%). The clinical success rate for EUS-guided ablation techniques was 98.5%. The median glucose level was 1.95 (Q1-Q3: 1.69–2.13) mmol/L before ablation compared to 6.20 (Q1-Q3: 5.30–7.05) mmol/L after treatment. The median insulin and C-peptide levels before and after RFA/EA were 230 (Q1–Q2: 120–257) pmol/L and 41 (Q1–Q2 35–42) pmol/L; 2077 (Q1–Q2 1644–2459) pmol/L and 819 (Q1–Q2 696–1072) pmol/L, respectively. There were eleven adverse events: seven abdominal pain, two mild acute pancreatitis, one necrotising acute pancreatitis and one local hematoma. All patients recovered, and there were no periprocedural deaths. Conclusions: EUS-guided ablation of insulinoma seems to be a safe and effective treatment and is an alternative to surgical resection in selected cases.

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