Endoscopy-guided ablation of pancreatic lesions:Technical possibilities and clinical outlook

• 作者: Alessandro Repici Gabriele Capurso Gianfranco Delle Fave Marianna Signoretti Roberto Valente Silvia Carrara
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: 内视镜的脱离 Radiofrequency 脱离 CRYOABLATION 内视镜的指导超声的脱离 乙醇 白酒脱离 Chemoablation 内视镜的超声 胰腺的癌症 内视镜后退 cholagiopancreatography 胰腺的膀胱的瘤 胰腺的内分泌的瘤
• 年，卷（期）: 2017,（2）
• 页码范围: 41-54
• 页数: 14页
• 分类号: R735.9

摘要

Endoscopic ultrasound(EUS) and endoscopic retrograde cholangiopancreatography(ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer(LAPC), pancreatic neuroendocrine tumours(PNETs), and pancreatic cystic lesions(PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as wel as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting.Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches,and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.