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Minerva Gastroenterology 2021 Apr 19

DOI: 10.23736/S2724-5985.21.02866-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

EUS-guided ablation of pancreatic neoplasms

Mihai RIMBAȘ 1, 2, Gianenrico RIZZATTI 3, Alberto LARGHI 3, 4

1 Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; 2 Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania; 3 Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 4 CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy


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Ablative therapies for locoregional treatment of pancreatic neoplastic lesions developed over the last decade to be applied during surgery are now becoming also available to be utilized under endoscopic ultrasound (EUS) guidance. The advantage of this approach is clear because of the close proximity of the EUS transducer to the target lesion, coupled with developments of specifically designed ablation devices, making the procedure minimally invasive, and potentially sparing patients from the morbidity of this method when performed surgically. EUS-guided ablative techniques that have been applied to pancreatic neoplastic cysts, pancreatic functional and non-functional neuroendocrine neoplasms and pancreatic ductal adenocarcinoma include ethanol injection, radiofrequency ablation (RFA), a combination of bipolar RFA and cryoablation, laser therapy (LT) and photodynamic therapy (PDT). Up to now, most of these procedures have been applied to patients at high surgical risk or who refused surgery. However, more studies evaluating some of these treatments also in selected patients not at surgical risk are becoming available. These studies will pave the road to apply this therapeutic approach to a more extensive number of patients, alone or in association with other therapies, such as immunomodulating drugs. The present manuscript will critically review the available evidence in the field of EUS-guided local ablative treatment of solid and cystic pancreatic neoplasms.


KEY WORDS: Endoscopic ultrasound; Pancreatic neoplasm; Pancreatic neuroendocrine neoplasm; Pancreatic cystic neoplasm; Pancreatic adenocarcinoma

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