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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2017; 9(2): 41-54
Published online Feb 16, 2017. doi: 10.4253/wjge.v9.i2.41
Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook
Marianna Signoretti, Roberto Valente, Alessandro Repici, Gianfranco Delle Fave, Gabriele Capurso, Silvia Carrara
Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy
Alessandro Repici, Silvia Carrara, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20121 Milan, Italy
Author contributions: Signoretti M, Valente R, Capurso G and Carrara S designed the study; Signoretti M, Valente R, Repici A, Delle Fave G, Capurso G and Carrara S gave substantial contribution to acquisition and analysis of the data and drafting of the article; Signoretti M, Valente R, Capurso G and Carrara S revised the manuscript critically and approved the version to be published; Signoretti M and Valente R contributed equally to this manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gabriele Capurso, MD, PhD, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00199 Rome, Italy. gabriele.capurso@gmail.com
Telephone: +39-06-33775691 Fax: +39-06-33775526
Received: August 30, 2016
Peer-review started: September 2, 2016
First decision: September 29, 2016
Revised: October 19, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 16, 2017
Processing time: 168 Days and 11.3 Hours
Abstract

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 well 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.

Keywords: Endoscopic ablation; Radiofrequency ablation; Cryoablation; Endoscopic ultrasound-guided ablation; Ethanol; Alcohol ablation; Chemoablation; Endoscopic ultrasound; Pancreatic cancer; Endoscopic retrograde cholagiopancreatography; Pancreatic cystic neoplasm; Pancreatic endocrine tumours

Core tip: Endoscopic ablation is a procedure with interesting potential for the treatment of locally advanced pancreatic ductal adenocarcinoma, functioning pancreatic endocrine tumours, and pancreatic cystic neoplasms in patients unfit for surgery. There is limited evidence regarding the feasibility, safety, and efficacy of such treatments. Both endoscopic ultrasound and endoscopic retrograde cholangiopancreatography have been employed to guide ablation with several chemo-physical agents (including alcohol-chemo ablation, radiofrequency ablation, and cryo-therm-ablation). However, evidence regarding the best treatment and the ideal clinical setting for ablation strategies is still lacking. In the multidisciplinary approach to pancreatic cancers, these emerging local ablation techniques will probably be the future for individualized patient treatments.