Endoscopic Ethanol Ablation of Communicating Pancreatic Cystic Neoplasms
| Status: | Completed |
|---|---|
| Conditions: | Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/8/2014 |
| Start Date: | January 2010 |
| End Date: | January 2015 |
| Contact: | Magdalen Clemens |
| Email: | clemens.magdalen@mayo.edu |
| Phone: | 507-778-2555 |
Pancreatic cysts are common, and some pancreas cysts have malignant potential. Usual
treatment of these cysts is either observation or surgical removal of part or all of the
pancreas. Minimally invasive treatment via endoscopy has been described, using endoscopic
ultrasound (EUS) guided ethanol injections. Such studies exclude cysts that communicate with
the main pancreatic duct, to avoid burning the main pancreatic duct with ethanol. In this
study, pancreas cysts communicating with the main pancreas duct are treated with ethanol via
endoscopic retrograde cholangiopancreatography (ERCP) and/or EUS.
treatment of these cysts is either observation or surgical removal of part or all of the
pancreas. Minimally invasive treatment via endoscopy has been described, using endoscopic
ultrasound (EUS) guided ethanol injections. Such studies exclude cysts that communicate with
the main pancreatic duct, to avoid burning the main pancreatic duct with ethanol. In this
study, pancreas cysts communicating with the main pancreas duct are treated with ethanol via
endoscopic retrograde cholangiopancreatography (ERCP) and/or EUS.
Subjects will undergo EUS and/or ERCP as outpatients. For cysts shown to communicate with
the main pancreas duct, a balloon catheter will be placed in the main pancreatic duct via
ERCP. The balloon catheter will isolate the cyst from the main pancreatic duct, allowing
ethanol injections of the cyst. A pancreatic duct stent will be placed in some patients,
requiring repeat endoscopy for removal at another time.
the main pancreas duct, a balloon catheter will be placed in the main pancreatic duct via
ERCP. The balloon catheter will isolate the cyst from the main pancreatic duct, allowing
ethanol injections of the cyst. A pancreatic duct stent will be placed in some patients,
requiring repeat endoscopy for removal at another time.
Inclusion Criteria:
- Presence of a pancreatic cystic lesion, at least 2 cm in maximum diameter
- Cyst may communicate, or definitely communicates, with the pancreatic duct (based on
prior CT, MR, ERCP, or EUS images)
- Treatment of the cystic lesion is desired due to symptoms or concern for subsequent
malignancy
- Age at least 18 years
- Able to give informed consent
- Surgical treatment has been considered and a surgical consultation offered to the
patient, OR the subject's cyst does not meet consensus criteria for surgical
resection. (Current consensus criteria for resection are one or more of the
following: cyst is symptomatic, ≥ 3 cm in diameter, contains a mural nodule, cytology
of cyst fluid is positive for malignancy, or main pancreatic duct diameter is > 6
mm.)
Exclusion Criteria:
- Known or suspected pregnancy, or nursing
- History of pancreatitis within 3 months prior to study endoscopy procedures
- Cyst has a primarily microcystic architecture on EUS
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