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World J Gastrointest Endosc. Apr 16, 2013; 5(4): 141-147
Published online Apr 16, 2013. doi: 10.4253/wjge.v5.i4.141
Tumors and new endoscopic ultrasound-guided therapies
Silvia Carrara, Maria Chiara Petrone, Pier Alberto Testoni, Paolo Giorgio Arcidiacono
Silvia Carrara, Maria Chiara Petrone, Pier Alberto Testoni, Paolo Giorgio Arcidiacono, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy
Author contributions: All the authors gave substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Correspondence to: Silvia Carrara, MD, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy. carrara.silvia@hsr.it
Telephone: +39-22-6435509 Fax: +39-22-6435509
Received: September 13, 2012
Revised: February 17, 2013
Accepted: March 8, 2013
Published online: April 16, 2013
Processing time: 215 Days and 4.5 Hours
Abstract

With the advent of linear echoendoscopes, endoscopic ultrasound (EUS) has become more operative and a new field of oncological application has been opened up. From tumor staging to tissue acquisition under EUS-guided fine-needle aspiration, new operative procedures have been developed on the principle of the EUS-guided puncture. A hybrid probe combining radiofrequency with cryotechnology is now available, to be passed through the operative channel of the echoendoscope into the tumor to create an area of ablation. EUS-guided fine-needle injection is emerging as a method to deliver anti-tumoral agents inside the tumor. Ethanol lavage, with or without paclitaxel, has been proposed for the treatment of cystic tumors in non-resectable cases and complete resolution has been recorded in up to 70%-80%. Many other chemical or biological agents have been investigated for the treatment of pancreatic adenocarcinoma: activated allogenic lymphocyte culture (Cytoimplant), a replication-deficient adenovirus vector carrying the tumor necrosis factor-α gene, or an oncolytic attenuated adenovirus (ONYX-015). The potential advantage of treatment under EUS control is the real-time imaging guidance into a deep target like the pancreas which is extremely difficult to reach by a percutaneous approach. To date there are no randomized controlled trials to confirm the real clinical benefits of these treatments compared to standard therapy so it seems wise to reserve them only for experimental protocols approved by ethics committees.

Keywords: Endoscopic ultrasound; Pancreatic cancer; Endoscopic ultrasound guided ablation; Alcohol injection; Anti-tumoral injection

Core tip: New operative procedures have been developed on the principle of the endoscopic ultrasound (EUS)-guided puncture. A hybrid probe combining radiofrequency with cryotechnology is now available, to be passed through the operative channel of the echoendoscope into the tumor to create an area of ablation. The potential advantage of an ablation device employed under EUS control is the real-time imaging guidance into a deep target like the pancreas which is extremely difficult to reach by a percutaneous approach.