Skip to main content
View expanded cover

Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS pp 305–323Cite as

EUS-Assisted Ablation Techniques

  • 370 Accesses

Abstract

EUS-guided ablation techniques have a very promising rationale and are aimed to achieve destruction of tissues using a minimal invasive and real-time imaging modality. They may be applied in the treatment of pancreatic masses as endocrine tumour, cystic lesions and adenocarcinoma. Current literature pointed out their feasibility and safety; however, the value of the majority of the studies is hampered by small sample size and lack of control group. Large multicentre clinical trials are needed to establish indications and clinical efficacy.

The present chapter presents the indications and technical features of the most important EUS-assisted ablative techniques and the future perspectives in pancreatic disease.

Keywords

  • Pancreatic adenocarcinoma
  • Pancreatic neuroendocrine tumour
  • Pancreatic cyst
  • Radiofrequency ablation
  • Cryotherm ablation
  • Photodynamic ablation
  • Nd:YAG ablation
  • Ethanol/alcohol injection
  • Cytoimplant
  • Dendritic cells

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-42569-2_29
  • Chapter length: 19 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   129.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-42569-2
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   169.99
Price excludes VAT (USA)
Hardcover Book
USD   249.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 29.1
Fig. 29.2
Fig. 29.3
Fig. 29.4
Fig. 29.5
Fig. 29.6

References

  1. DiMagno EP, DiMagno MJ. Endoscopic ultrasonography: from the origins to routine EUS. Dig Dis Sci. 2016;61(2):342–53.

    PubMed  CrossRef  Google Scholar 

  2. Teoh AYB, Dhir V, Kida M, Yasuda I, Jin ZD, Seo DW, et al. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut. 2018;67(7):1209–28.

    PubMed  CrossRef  Google Scholar 

  3. Law R, Baron TH. Endoscopic ultrasound-guided gallbladder drainage. Gastrointest Endosc Clin N Am. 2018;28(2):187–95.

    PubMed  CrossRef  Google Scholar 

  4. Siddiqui UD, Levy MJ. EUS-guided transluminal interventions. Gastroenterology. 2018;154(7):1911–24.

    PubMed  CrossRef  Google Scholar 

  5. Artifon ELA, Marson FP, Khan MA. Endoscopic ultrasonography-guided hemostasis techniques. Gastrointest Endosc Clin N Am. 2017;27(4):741–7.

    PubMed  CrossRef  Google Scholar 

  6. Anderloni A, Attili F, Carrara S, Galasso D, Di Leo M, Costamagna G, et al. Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm. Endosc Int Open. 2017;5(1):E25–E9.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  7. Dhadham GC, Hoffe S, Harris CL, Klapman JB. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility. Endosc Int Open. 2016;4(3):E378–82.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  8. Carrara S, Di Leo M, Zerbi A. The golden compass to the depths. Gastroenterology. 2016;151(5):e7–8.

    PubMed  CrossRef  Google Scholar 

  9. Signoretti M, Valente R, Repici A, Delle Fave G, Capurso G, Carrara S. Endoscopy-guided ablation of pancreatic lesions: technical possibilities and clinical outlook. World J Gastrointest Endosc. 2017;9(2):41–54.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  10. Dabizzi E, Arcidiacono PG. EUS-guided solid pancreatic tumor ablation. Endosc Ultrasound. 2017;6(Suppl 3):S90–S4.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  11. Kaplan J, Khalid A, Cosgrove N, Soomro A, Mazhar SM, Siddiqui AA. Endoscopic ultrasound-fine needle injection for oncological therapy. World J Gastrointest Oncol. 2015;7(12):466–72.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  12. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    PubMed  CrossRef  Google Scholar 

  13. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    CAS  PubMed  CrossRef  Google Scholar 

  14. Iacobuzio-Donahue CA, Fu B, Yachida S, Luo M, Abe H, Henderson CM, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 2009;27(11):1806–13.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  15. Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2017;15(8):1028–61.

    CrossRef  Google Scholar 

  16. Linee Guida AIOM (Associazione italiana oncologia medica) Guidelines for exocrine pancreatic cancer. 2017.

    Google Scholar 

  17. Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008;19(10):1727–33.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  18. Yao JC, Eisner MP, Leary C, Dagohoy C, Phan A, Rashid A, et al. Population-based study of islet cell carcinoma. Ann Surg Oncol. 2007;14(12):3492–500.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  19. Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin N Am. 2011;40(1):1–18, vii.

    CrossRef  Google Scholar 

  20. Kuo EJ, Salem RR. Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol. 2013;20(9):2815–21.

    PubMed  CrossRef  Google Scholar 

  21. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. 2000;95(9):2271–7.

    CAS  PubMed  CrossRef  Google Scholar 

  22. Ardengh JC, Rosenbaum P, Ganc AJ, Goldenberg A, Lobo EJ, Malheiros CA, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc. 2000;51(5):552–5.

    CAS  PubMed  CrossRef  Google Scholar 

  23. Farrell JM, Pang JC, Kim GE, Tabatabai ZL. Pancreatic neuroendocrine tumors: accurate grading with Ki-67 index on fine-needle aspiration specimens using the WHO 2010/ENETS criteria. Cancer Cytopathol. 2014;122(10):770–8.

    PubMed  CrossRef  Google Scholar 

  24. Weynand B, Borbath I, Bernard V, Sempoux C, Gigot JF, Hubert C, et al. Pancreatic neuroendocrine tumour grading on endoscopic ultrasound-guided fine needle aspiration: high reproducibility and inter-observer agreement of the Ki-67 labelling index. Cytopathology. 2014;25(6):389–95.

    CAS  PubMed  Google Scholar 

  25. Lennon AM, Newman N, Makary MA, Edil BH, Shin EJ, Khashab MA, et al. EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc. 2010;72(5):1089–94.

    PubMed  CrossRef  Google Scholar 

  26. Lakhtakia S. Therapy of pancreatic neuroendocrine tumors: fine needle intervention including ethanol and radiofrequency ablation. Clin Endosc. 2017;50(6):546–51.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  27. Choi JH, Seo DW, Song TJ, Park DH, Lee SS, Lee SK, et al. Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors. Endoscopy. 2018;50(11):1099–104.

    PubMed  CrossRef  Google Scholar 

  28. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology. 2016;103(2):153–71.

    CAS  PubMed  CrossRef  Google Scholar 

  29. Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105(9):2079–84.

    PubMed  CrossRef  Google Scholar 

  30. Karoumpalis I, Christodoulou DK. Cystic lesions of the pancreas. Ann Gastroenterol. 2016;29(2):155–61.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  31. Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.

    PubMed  CrossRef  Google Scholar 

  32. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738–53.

    PubMed  CrossRef  Google Scholar 

  33. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67(5):789–804.

    CrossRef  Google Scholar 

  34. Sawai Y, Yamao K, Bhatia V, Chiba T, Mizuno N, Sawaki A, et al. Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy. 2010;42(12):1077–84.

    CAS  PubMed  CrossRef  Google Scholar 

  35. Armellini E, Leutner M, Stradella D, Ballare M, Occhipinti P. EUS-guided radiofrequency ablation: an option for the extrapancreatic region. Endosc Ultrasound. 2018;7(4):282–3.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  36. Di Matteo F, Grasso R, Pacella CM, Martino M, Pandolfi M, Rea R, et al. EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe. Gastrointest Endosc. 2011;73(3):632–6.

    PubMed  CrossRef  Google Scholar 

  37. Nakaji S, Hirata N, Iwaki K, Shiratori T, Kobayashi M, Inase M. Endoscopic ultrasound (EUS)-guided ethanol injection for hepatocellular carcinoma difficult to treat with percutaneous local treatment. Endoscopy. 2012;44(Suppl 2 UCTN):E380.

    PubMed  Google Scholar 

  38. Lee S, Seo DW, Paik WH, Park DH, Lee SS, Lee SK, et al. Ethanol lavage of huge hepatic cysts by using EUS guidance and a percutaneous approach. Gastrointest Endosc. 2014;80(6):1014–21.

    PubMed  CrossRef  Google Scholar 

  39. DeWitt J, Mohamadnejad M. EUS-guided alcohol ablation of metastatic pelvic lymph nodes after endoscopic resection of polypoid rectal cancer: the need for long-term surveillance. Gastrointest Endosc. 2011;74(2):446–7.

    PubMed  CrossRef  Google Scholar 

  40. Artifon EL, Lucon AM, Sakai P, Gerhardt R, Srougi M, Takagaki T, et al. EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma. Gastrointest Endosc. 2007;66(6):1201–5.

    PubMed  CrossRef  Google Scholar 

  41. Paiella S, Salvia R, Ramera M, Girelli R, Frigerio I, Giardino A, et al. Local ablative strategies for ductal pancreatic cancer (radiofrequency ablation, irreversible electroporation): a review. Gastroenterol Res Pract. 2016;2016:4508376.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  42. Haen SP, Pereira PL, Salih HR, Rammensee HG, Gouttefangeas C. More than just tumor destruction: immunomodulation by thermal ablation of cancer. Clin Dev Immunol. 2011;2011:160250.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  43. Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer. 2014;14(3):199–208.

    CAS  PubMed  CrossRef  Google Scholar 

  44. Laquiere A, Boustiere C, Leblanc S, Penaranda G, Desilets E, Prat F. Safety and feasibility of endoscopic biliary radiofrequency ablation treatment of extrahepatic cholangiocarcinoma. Surg Endosc. 2016;30(3):1242–8.

    CAS  PubMed  CrossRef  Google Scholar 

  45. Girelli R, Frigerio I, Giardino A, Regi P, Gobbo S, Malleo G, et al. Results of 100 pancreatic radiofrequency ablations in the context of a multimodal strategy for stage III ductal adenocarcinoma. Langenbeck's Arch Surg. 2013;398(1):63–9.

    CrossRef  Google Scholar 

  46. Wu Y, Tang Z, Fang H, Gao S, Chen J, Wang Y, et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol. 2006;94(5):392–5.

    PubMed  CrossRef  Google Scholar 

  47. Spiliotis JD, Datsis AC, Michalopoulos NV, Kekelos SP, Vaxevanidou A, Rogdakis AG, et al. Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas. Langenbeck's Arch Surg. 2007;392(1):55–60.

    CrossRef  Google Scholar 

  48. Spiliotis JD, Datsis AC, Michalopoulos NV, Kekelos SP, Vaxevanidou A, Rogdakis AG, et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol. 2007;96(1):89–90.

    PubMed  CrossRef  Google Scholar 

  49. Paik WH, Seo DW. Echoendoscopic ablative therapy for solid pancreatic tumors. J Dig Dis. 2017;18(3):135–42.

    PubMed  CrossRef  Google Scholar 

  50. Yoon WJ, Brugge WR. Endoscopic ultrasonography-guided tumor ablation. Gastrointest Endosc Clin N Am. 2012;22(2):359–69, xi.

    PubMed  CrossRef  Google Scholar 

  51. Goldberg SN, Mallery S, Gazelle GS, Brugge WR. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc. 1999;50(3):392–401.

    CAS  PubMed  CrossRef  Google Scholar 

  52. Varadarajulu S, Jhala NC, Drelichman ER. EUS-guided radiofrequency ablation with a prototype electrode array system in an animal model (with video). Gastrointest Endosc. 2009;70(2):372–6.

    PubMed  CrossRef  Google Scholar 

  53. Wang D, Jin Z, Lei W, Leung JW, Li Z. Mo1524 endoscopic ultrasound guided radiofrequency ablation for the treatment of advanced pancreatic carcinoma. Gastrointest Endosc. 2013;77(5 Suppl):AB414.

    Google Scholar 

  54. Rossi S, Viera FT, Ghittoni G, Cobianchi L, Rosa LL, Siciliani L, et al. Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas. 2014;43(6):938–45.

    PubMed  CrossRef  Google Scholar 

  55. Pai M, Habib N, Senturk H, Lakhtakia S, Reddy N, Cicinnati VR, et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg. 2015;7(4):52–9.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  56. Armellini E, Crino SF, Ballare M, Occhipinti P. Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor. Endoscopy. 2015;47(Suppl 1 UCTN):E600–1.

    PubMed  Google Scholar 

  57. Waung JA, Todd JF, Keane MG, Pereira SP. Successful management of a sporadic pancreatic insulinoma by endoscopic ultrasound-guided radiofrequency ablation. Endoscopy. 2016;48(Suppl 1):E144–5.

    PubMed  Google Scholar 

  58. Lakhtakia S, Ramchandani M, Galasso D, Gupta R, Venugopal S, Kalpala R, et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc. 2016;83(1):234–9.

    PubMed  CrossRef  Google Scholar 

  59. Song TJ, Seo DW, Lakhtakia S, Reddy N, Oh DW, Park DH, et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc. 2016;83(2):440–3.

    PubMed  CrossRef  Google Scholar 

  60. Goyal D, Cen P, Wray CJ, Rowe J, Guha S, Singhal S, et al. 1111 Feasibility, safety, and efficacy of endoscopic ultrasound (EUS) guided radiofrequency ablation (RFA) of the pancreatic lesions: single center us experience. Gastrointest Endosc. 2017;85(5):AB144.

    CrossRef  Google Scholar 

  61. Bas-Cutrina F, Bargallo D, Gornals JB. Small pancreatic insulinoma: successful endoscopic ultrasound-guided radiofrequency ablation in a single session using a 22-G fine needle. Dig Endosc. 2017;29(5):636–8.

    PubMed  CrossRef  Google Scholar 

  62. Feng X, Linghu E, Chai N, Li H. New treatment of the pancreatic cystic neoplasm: endoscopic ultrasonography-guided radiofrequency ablation combined with lauromacrogol ablation. Turk J Gastroenterol. 2018;29(1):99–102.

    CrossRef  Google Scholar 

  63. Crino SF, D’Onofrio M, Bernardoni L, Frulloni L, Iannelli M, Malleo G, et al. EUS-guided radiofrequency ablation (EUS-RFA) of solid pancreatic neoplasm using an 18-gauge needle electrode: feasibility, safety, and technical success. J Gastrointestin Liver Dis. 2018;27(1):67–72.

    PubMed  CrossRef  Google Scholar 

  64. Malikowski T, Gleeson FC, Block M, Chari ST, Abu Dayyeh BK, Kendrick ML, et al. Mo1268 endoscopic ultrasound guided radiofrequency ablation (EUS-RFA): initial assessment of safety and efficacy. Gastrointest Endosc. 2017;85(5 Suppl):AB484.

    CrossRef  Google Scholar 

  65. Scopelliti F, Pea A, Conigliaro R, Butturini G, Frigerio I, Regi P, et al. Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer. Surg Endosc. 2018;32(9):4022–8.

    PubMed  CrossRef  Google Scholar 

  66. Hines-Peralta A, Hollander CY, Solazzo S, Horkan C, Liu ZJ, Goldberg SN. Hybrid radiofrequency and cryoablation device: preliminary results in an animal model. J Vasc Interv Radiol. 2004;15(10):1111–20.

    PubMed  CrossRef  Google Scholar 

  67. Van Goethem BE, Rosenveldt KW, Kirpensteijn J. Monopolar versus bipolar electrocoagulation in canine laparoscopic ovariectomy: a nonrandomized, prospective, clinical trial. Vet Surg. 2003;32(5):464–70.

    PubMed  CrossRef  Google Scholar 

  68. Lee JM, Han JK, Choi SH, Kim SH, Lee JY, Shin KS, et al. Comparison of renal ablation with monopolar radiofrequency and hypertonic-saline-augmented bipolar radiofrequency: in vitro and in vivo experimental studies. AJR Am J Roentgenol. 2005;184(3):897–905.

    PubMed  CrossRef  Google Scholar 

  69. Joosten JJ, van Muijen GN, Wobbes T, Ruers TJ. Cryosurgery of tumor tissue causes endotoxin tolerance through an inflammatory response. Anticancer Res. 2003;23(1A):427–32.

    CAS  PubMed  Google Scholar 

  70. Sabel MS, Arora A, Su G, Chang AE. Adoptive immunotherapy of breast cancer with lymph node cells primed by cryoablation of the primary tumor. Cryobiology. 2006;53(3):360–6.

    CAS  PubMed  CrossRef  Google Scholar 

  71. Zhu J, Zhang Y, Zhang A, He K, Liu P, Xu LX. Cryo-thermal therapy elicits potent anti-tumor immunity by inducing extracellular Hsp70-dependent MDSC differentiation. Sci Rep. 2016;6:27136.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  72. Carrara S, Arcidiacono PG, Albarello L, Addis A, Enderle MD, Boemo C, et al. Endoscopic ultrasound-guided application of a new internally gas-cooled radiofrequency ablation probe in the liver and spleen of an animal model: a preliminary study. Endoscopy. 2008;40(9):759–63.

    CAS  PubMed  CrossRef  Google Scholar 

  73. Arcidiacono PG, Carrara S, Reni M, Petrone MC, Cappio S, Balzano G, et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc. 2012;76(6):1142–51.

    PubMed  CrossRef  Google Scholar 

  74. Park DH, Lee SS, Park SE, Lee JL, Choi JH, Choi HJ, et al. Randomised phase II trial of photodynamic therapy plus oral fluoropyrimidine, S-1, versus photodynamic therapy alone for unresectable hilar cholangiocarcinoma. Eur J Cancer. 2014;50(7):1259–68.

    CAS  PubMed  CrossRef  Google Scholar 

  75. Ayaru L, Wittmann J, Macrobert AJ, Novelli M, Bown SG, Pereira SP. Photodynamic therapy using verteporfin photosensitization in the pancreas and surrounding tissues in the Syrian golden hamster. Pancreatology. 2007;7(1):20–7.

    CAS  PubMed  CrossRef  Google Scholar 

  76. Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111(8):1576–84.

    PubMed  CrossRef  Google Scholar 

  77. Yusuf TE, Matthes K, Brugge WR. EUS-guided photodynamic therapy with verteporfin for ablation of normal pancreatic tissue: a pilot study in a porcine model (with video). Gastrointest Endosc. 2008;67(6):957–61.

    PubMed  CrossRef  Google Scholar 

  78. Choi JH, Oh D, Lee JH, Park JH, Kim KP, Lee SS, et al. Initial human experience of endoscopic ultrasound-guided photodynamic therapy with a novel photosensitizer and a flexible laser-light catheter. Endoscopy. 2015;47(11):1035–8.

    PubMed  CrossRef  Google Scholar 

  79. Schena E, Saccomandi P, Fong Y. Laser ablation for cancer: past, present and future. J Funct Biomater. 2017;8(2).

    Google Scholar 

  80. Stafford RJ, Fuentes D, Elliott AA, Weinberg JS, Ahrar K. Laser-induced thermal therapy for tumor ablation. Crit Rev Biomed Eng. 2010;38(1):79–100.

    PubMed  CrossRef  Google Scholar 

  81. Di Matteo F, Martino M, Rea R, Pandolfi M, Rabitti C, Masselli GM, et al. EUS-guided Nd:YAG laser ablation of normal pancreatic tissue: a pilot study in a pig model. Gastrointest Endosc. 2010;72(2):358–63.

    PubMed  CrossRef  Google Scholar 

  82. Di Matteo F, Martino M, Rea R, Pandolfi M, Panzera F, Stigliano E, et al. US-guided application of Nd:YAG laser in porcine pancreatic tissue: an ex vivo study and numerical simulation. Gastrointest Endosc. 2013;78(5):750–5.

    PubMed  CrossRef  Google Scholar 

  83. Di Matteo F, Picconi F, Martino M, Pandolfi M, Pacella CM, Schena E, et al. Endoscopic ultrasound-guided Nd:YAG laser ablation of recurrent pancreatic neuroendocrine tumor: a promising revolution? Endoscopy. 2014;46(Suppl 1 UCTN):E380–1.

    PubMed  Google Scholar 

  84. Di Matteo FM, Saccomandi P, Martino M, Pandolfi M, Pizzicannella M, Balassone V, et al. Feasibility of EUS-guided Nd:YAG laser ablation of unresectable pancreatic adenocarcinoma. Gastrointest Endosc. 2018;88(1):168–74.e1.

    PubMed  CrossRef  Google Scholar 

  85. Zhang WY, Li ZS, Jin ZD. Endoscopic ultrasound-guided ethanol ablation therapy for tumors. World J Gastroenterol. 2013;19(22):3397–403.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  86. Gelczer RK, Charboneau JW, Hussain S, Brown DL. Complications of percutaneous ethanol ablation. J Ultrasound Med. 1998;17(8):531–3.

    CAS  PubMed  CrossRef  Google Scholar 

  87. Wyse JM, Battat R, Sun S, Saftoiu A, Siddiqui AA, Leong AT, et al. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound. 2017;6(6):369–75.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  88. DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc. 2009;70(4):710–23.

    PubMed  CrossRef  Google Scholar 

  89. DiMaio CJ, DeWitt JM, Brugge WR. Ablation of pancreatic cystic lesions: the use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas. 2011;40(5):664–8.

    PubMed  CrossRef  Google Scholar 

  90. Gan SI, Thompson CC, Lauwers GY, Bounds BC, Brugge WR. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc. 2005;61(6):746–52.

    PubMed  CrossRef  Google Scholar 

  91. Moyer MT, Dye CE, Sharzehi S, Ancrile B, Mathew A, McGarrity TJ, et al. Is alcohol required for effective pancreatic cyst ablation? The prospective randomized CHARM trial pilot study. Endosc Int Open. 2016;4(5):E603–7.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  92. Oh HC, Seo DW, Kim SC, Yu E, Kim K, Moon SH, et al. Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention? Scand J Gastroenterol. 2009;44(2):242–7.

    PubMed  CrossRef  Google Scholar 

  93. Oh HC, Seo DW, Lee TY, Kim JY, Lee SS, Lee SK, et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc. 2008;67(4):636–42.

    PubMed  CrossRef  Google Scholar 

  94. Oh HC, Seo DW, Song TJ, Moon SH, Park DH, Soo Lee S, et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology. 2011;140(1):172–9.

    CAS  PubMed  CrossRef  Google Scholar 

  95. Park JK, Song BJ, Ryu JK, Paik WH, Park JM, Kim J, et al. Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation. Pancreas. 2016;45(6):889–94.

    PubMed  CrossRef  Google Scholar 

  96. Kandula M, Moole H, Cashman M, Volmar FH, Bechtold ML, Puli SR. Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: a meta-analysis and systematic review. Indian J Gastroenterol. 2015;34(3):193–9.

    PubMed  CrossRef  Google Scholar 

  97. Facciorusso A, Di Maso M, Serviddio G, Larghi A, Costamagna G, Muscatiello N. Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma. J Gastroenterol Hepatol. 2017;32(2):439–45.

    CAS  PubMed  CrossRef  Google Scholar 

  98. Bor R, Farkas K, Balint A, Molnar T, Nagy F, Valkusz Z, et al. Endoscopic ultrasound-guided ethanol ablation: an alternative option for the treatment of pancreatic insulinoma. Orv Hetil. 2014;155(41):1647–51.

    PubMed  CrossRef  Google Scholar 

  99. Burghardt K, Kaemmerer D, Michael A, Aschenbach R, Muller UA, Kloos C, et al. Successful endoscopic ultrasound-guided ethanol ablation of a symptomatic sporadic insulinoma in a patient with severe comorbidities not suitable for pancreatic surgery. Diabetes Metab. 2018;44(1):84–6.

    CAS  PubMed  CrossRef  Google Scholar 

  100. Dabkowski K, Gajewska P, Walter K, Londzin-Olesik M, Bialek A, Andrysiak-Mammos E, et al. Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review. Endokrynol Pol. 2017;68(4):472–9.

    PubMed  CrossRef  Google Scholar 

  101. Deprez PH, Claessens A, Borbath I, Gigot JF, Maiter D. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroenterol Belg. 2008;71(3):333–7.

    PubMed  Google Scholar 

  102. Jurgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stolzel U. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63(7):1059–62.

    PubMed  CrossRef  Google Scholar 

  103. Lee MJ, Jung CH, Jang JE, Hwang JY, Park DH, Park TS, et al. Successful endoscopic ultrasound-guided ethanol ablation of multiple insulinomas accompanied with multiple endocrine neoplasia type 1. Intern Med J. 2013;43(8):948–50.

    CAS  PubMed  CrossRef  Google Scholar 

  104. Levy MJ, Thompson GB, Topazian MD, Callstrom MR, Grant CS, Vella A. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc. 2012;75(1):200–6.

    PubMed  CrossRef  Google Scholar 

  105. Luo Y, Li J, Yang A, Yang H, Li F. 68Ga-Exendin-4 PET/CT in evaluation of endoscopic ultrasound-guided ethanol ablation of an insulinoma. Clin Nucl Med. 2017;42(4):310–1.

    PubMed  CrossRef  Google Scholar 

  106. Muscatiello N, Salcuni A, Macarini L, Cignarelli M, Prencipe S, di Maso M, et al. Treatment of a pancreatic endocrine tumor by ethanol injection guided by endoscopic ultrasound. Endoscopy. 2008;40(Suppl 2):E258–9.

    PubMed  CrossRef  Google Scholar 

  107. Paik WH, Seo DW, Dhir V, Wang HP. Safety and efficacy of EUS-guided ethanol ablation for treating small solid pancreatic neoplasm. Medicine (Baltimore). 2016;95(4):e2538.

    CAS  CrossRef  Google Scholar 

  108. Park DH, Choi JH, Oh D, Lee SS, Seo DW, Lee SK, et al. Endoscopic ultrasonography-guided ethanol ablation for small pancreatic neuroendocrine tumors: results of a pilot study. Clin Endosc. 2015;48(2):158–64.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  109. Qin SY, Lu XP, Jiang HX. EUS-guided ethanol ablation of insulinomas: case series and literature review. Medicine (Baltimore). 2014;93(14):e85.

    CrossRef  Google Scholar 

  110. Schnack C, Hansen CO, Beck-Nielsen H, Mortensen PM. [Treatment of insulinomas with alcoholic ablation]. Ugeskr Laeger. 2012;174(8):501–2.

    Google Scholar 

  111. Teoh AY, Chong CC, Chan AW, Lau JY. EUS-guided alcohol injection of pancreatic neuroendocrine tumor. Gastrointest Endosc. 2015;82(1):167.

    PubMed  CrossRef  Google Scholar 

  112. Trikudanathan G, Mallery SJ, Amateau SK. Successful endoscopic ultrasound-guided alcohol ablation of sporadic insulinoma using three-dimensional targeting (with video). Clin Endosc. 2016;49(4):399–401.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  113. Vleggaar FP, Bij de Vaate EA, Valk GD, Leguit RJ, Siersema PD. Endoscopic ultrasound-guided ethanol ablation of a symptomatic sporadic insulinoma. Endoscopy. 2011;43(Suppl 2 UCTN):E328–9.

    PubMed  CrossRef  Google Scholar 

  114. Yang D, Inabnet WB III, Sarpel U, DiMaio CJ. EUS-guided ethanol ablation of symptomatic pancreatic insulinomas. Gastrointest Endosc. 2015;82(6):1127.

    PubMed  CrossRef  Google Scholar 

  115. Levy MJ, Alberts SR, Bamlet WR, Burch PA, Farnell MB, Gleeson FC, et al. EUS-guided fine-needle injection of gemcitabine for locally advanced and metastatic pancreatic cancer. Gastrointest Endosc. 2017;86(1):161–9.

    PubMed  CrossRef  Google Scholar 

  116. Chang KJ, Nguyen PT, Thompson JA, Kurosaki TT, Casey LR, Leung EC, et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88(6):1325–35.

    CAS  PubMed  CrossRef  Google Scholar 

  117. Hirooka Y, Itoh A, Kawashima H, Hara K, Nonogaki K, Kasugai T, et al. A combination therapy of gemcitabine with immunotherapy for patients with inoperable locally advanced pancreatic cancer. Pancreas. 2009;38(3):e69–74.

    CAS  PubMed  CrossRef  Google Scholar 

  118. Irisawa A, Takagi T, Kanazawa M, Ogata T, Sato Y, Takenoshita S, et al. Endoscopic ultrasound-guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas. 2007;35(2):189–90.

    PubMed  CrossRef  Google Scholar 

  119. Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Kamigaki T, Goto S, et al. Comprehensive immunotherapy combined with intratumoral injection of zoledronate-pulsed dendritic cells, intravenous adoptive activated T lymphocyte and gemcitabine in unresectable locally advanced pancreatic carcinoma: a phase I/II trial. Oncotarget. 2018;9(2):2838–47.

    PubMed  CrossRef  Google Scholar 

  120. Endo H, Saito T, Kenjo A, Hoshino M, Terashima M, Sato T, et al. Phase I trial of preoperative intratumoral injection of immature dendritic cells and OK-432 for resectable pancreatic cancer patients. J Hepatobiliary Pancreat Sci. 2012;19(4):465–75.

    PubMed  CrossRef  Google Scholar 

  121. Hecht JR, Bedford R, Abbruzzese JL, Lahoti S, Reid TR, Soetikno RM, et al. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res. 2003;9(2):555–61.

    CAS  PubMed  Google Scholar 

  122. Hecht JR, Farrell JJ, Senzer N, Nemunaitis J, Rosemurgy A, Chung T, et al. EUS or percutaneously guided intratumoral TNFerade biologic with 5-fluorouracil and radiotherapy for first-line treatment of locally advanced pancreatic cancer: a phase I/II study. Gastrointest Endosc. 2012;75(2):332–8.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  123. Herman JM, Wild AT, Wang H, Tran PT, Chang KJ, Taylor GE, et al. Randomized phase III multi-institutional study of TNFerade biologic with fluorouracil and radiotherapy for locally advanced pancreatic cancer: final results. J Clin Oncol. 2013;31(7):886–94.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  124. Hanna N, Ohana P, Konikoff FM, Leichtmann G, Hubert A, Appelbaum L, et al. Phase 1/2a, dose-escalation, safety, pharmacokinetic and preliminary efficacy study of intratumoral administration of BC-819 in patients with unresectable pancreatic cancer. Cancer Gene Ther. 2012;19(6):374–81.

    CAS  PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy

    Silvia Carrara & Milena Di Leo

Authors
  1. Silvia Carrara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Milena Di Leo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Silvia Carrara .

Editor information

Editors and Affiliations

  1. Digestive and Interventional Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, Milano, Italy

    Massimiliano Mutignani

  2. Hepatologie und Endokrinologie, Abteilung für Gastroenterologie, Robert-Bosch-Krankenhaus, Auerbachstraße, Stuttgart, Germany

    Jörg G. Albert

  3. Department of Gastroenterology, Azienda USL di Forlì-Cesena, Bologna, Italy

    Carlo Fabbri

Rights and permissions

Reprints and Permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Carrara, S., Di Leo, M. (2020). EUS-Assisted Ablation Techniques. In: Mutignani, M., Albert, J.G., Fabbri, C. (eds) Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS. Springer, Cham. https://doi.org/10.1007/978-3-030-42569-2_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-42569-2_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42568-5

  • Online ISBN: 978-3-030-42569-2

  • eBook Packages: MedicineMedicine (R0)