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

Table 1 Characteristics and findings of studies of endoscopy-guided ablation for locally advanced pancreatic adenocarcinoma

Ref.	Year	No.	Endoscopy technique	Type of ablation	Stage of PDACn (%)	Median survival (mo)	Complications n (%)	Response rate n (%)
Chang et al[3]	2000	8	EUS-FNI	EUS-FNI Cytoimplant	4 (50) II 3 (37) III 1 (12.5) IV	13.2	8 (86) fever, 3 (37.5) GI toxicities, 3 (37.5) hyperbilirubinemia	3 (37) PR
Irisawa et al[85]	2007	7	EUS-FNI	EUS-FNI DCs	7 (100) IV	9.9	None	1 (14) CR 3 (43) PR
Hirooka et al[86]	2009	5	EUS-FNI	EUS-FNI DCs plus systemic GEM	5 (100) III	15.9	None	1 (20) PR
Hecht et al[4]	2003	21	EUS-FNI	ONYX-015 plus systemic GEM	3 (48) III 2 (52) IV	7.5	2 (10) sepsis, 2 (10) duodenal perforation, 2 (10) cystic fluid collection, 1 (5) fever	2 (10) PR
Hecht et al[87]	2012	50	EUS-FNI or percutaneous	TNFerade plus radiation and 5-FU	(100) III	13.2	6 (12) GI bleeding, 6 (12) deep vein thrombosis, 2 (4) pulmonary embolism, 9 (18) abdominal pain, 2 (4) pancreatitis, 1 (2) cholangitis	1 (2) CR 3 (6) PR
Herman et al[88]	2013	304	EUS-FNI or percutaneous	TNFerade plus radiation (180 pts) and 5-FU vs radiation and 5-FU (90 pts)	NR (Unresectable PDAC)	10 (the same in two groups) NR (7 pts alive at 6 mo and 2 at 12 mo)	34 (20) vs 10 (11) GI toxicities grade 3-4, 60 (33) vs 32 (35) hematologic toxicities grade 3-4, 22 (12) vs 7 (10), non-GI/nonhematologic toxicities (e.g., fever, fatigue) grade 3-4	8 (8.2) vs 6 (12) PR 3 PR
Hanna et al[89]	2012	9	EUS-FNI or percutaneous (TC-guided)	BC-819	8 (88.9) III 1 (10.1) IV		4 (44) gastrointestinal disorders, 2 (22) abdominal pain, 1 (11) influenza like illness, 1 (11) fatigue, 2 (22) back pain, 2 (22) hypertension 2 (22) metabolic disorders, 1 (11) syncope
Facciorusso et al[81]	2016	123	EUS-FNI	CPN plus ethanol (65 pts) vs CPN alone (58 pts)	25 (20.4) IV 98 (79.6) III	8.3 vs 6.5	16 (25) vs 14 (24) diarrhoea 31 (48) vs 11 (19) fever	NR
Waung et al[51]	2016	3	EUS-guided	RFA	3 (100) III	NR	30 (46) vs 20 (34) abdominal pain None	NR (14% mean reduction in size)
Song et al[48]	2016	6	EUS-guided	RFA	4 (67) III 2 (33) IV	NR	2 (33) abdominal pain	NR
Figueroa-Barojas et al[44]	2013	22	ERCP-guided	RFA	7 III plus 16 CHR 1 HGD IPMN	NR	5 (23) (1 pancreatitis post ERCP with cholecystitis, 5 abdominal pain)	NR
Kallis et al[45]	2015	69	ERCP-guided	RFA plus SEMS stenting (23 pts) vs SEMS stenting alone (46 pts)	100% III	7.5 vs 4.1	1 (1.4) cholangitis, 1 (1.4) asymptomatic hyperamylasaemia	NR

PDAC: Pancreatic ductal adenocarcinoma; EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholagiopancreatography; EUS-FNI: Endoscopic ultrasound fine-needle injection; RFA: Radiofrequency ablation; CHR: Cholangiocarcinoma; DCs: Dendritics cells; GEM: Gemcitabine; IPMN: Intraductal papillary mucinous neoplasia; SEMS: Self-expandable metal stent; NR: Not reported; CR: Complete response; PR: Partial response; 5-FU: 5-fluorouracil; CPN: Celiac plexus neurolysis; GI: Gastrointestinal; HGD: High grade dysplasia.