Comparison of outcomes of EUS-guided ablation and surveillance only for pancreatic cystic lesions: a propensity score–matching study (with videos)

Abstract

EUS-guided ethanol ablation (EUS-EA) is a recently introduced treatment approach for pancreatic cystic lesions (PCLs), including branch-duct-type intraductal papillary mucinous neoplasms (BD-IPMNs). However, the utility of this procedure is limited owing to its relatively low efficacy in treating PCLs. We retrospectively reviewed patients with PCLs, including those with enlarging suspected BD-IPMNs, or those with PCLs measuring >3cm who were suboptimal candidates for surgery and had been managed using EUS-guided rapid ethanol lavage (EUS-REL; four times of immediate ethanol lavage, 2015-2022) or surveillance-only (SO, 2007- 2022). Propensity score matching (PSM) was performed to minimize bias. The primary outcome was the cumulative incidence rate of BD-IPMN progression. Secondary outcomes were the efficacy and safety of EUS-REL, surgical resection rate (SR), overall survival (OS), and disease-specific survival (DSS) in both groups. Overall, 169 and 610 patients were included in the EUS and SO groups, respectively. PSM created 159 matched pairs. The radiologic complete resolution rate following EUS-REL was 74%. Procedure-related pancreatitis in the EUS group was 13.0% (n=22; 19 mild, and 3 moderate grade); no severe complication was reported. The 10-year cumulative incidence rate of BD-IPMN progression was significantly lower in the EUS group than in the SO group (1.6% vs 21.2%, hazard ratio 12.35, P = .003). EUS-REL showed a lower tendency of SR compared to that associated with SO. The 10-year OS and 10-year DSS were comparable in both groups. EUS-REL was associated with a significantly lower 10-year cumulative incidence rate of BD-IPMN progression and a lower tendency of SR, while its 10-year OS and DSS were similar to those of SO for PCLs. EUS-REL may be a viable alternative to SO for managing patients with enlarging suspected BD-IPMNs or those with PCLs >3cm who are suboptimal candidates for surgery.