EUS-guided Ethanol Lavage of Cystic Lesions of the Pancreas Is Feasible and Safe

Abstract

Introduction: Cystic lesions of the pancreas are increasingly discovered with the widespread use of CT and MRI scanning. EUS-FNA is often used to evaluate these lesions and determine the risk of malignancy. Since ethanol lavage is often used to ablate other epithelial cysts, this simple technique might be applicable to cystic lesions of the pancreas if there is a low risk of complications. Aim: We sought to determine the safety and feasibility of EUS-guided ethanol lavage in patients undergoing EUS-FNA of a cystic lesion. Methods: Patients at Mass. General Hospital with a 1-4cm macrocystic lesion of the pancreas were recruited over the past 2 years using an IRB-approved protocol. Exclusion criteria included evidence of active pancreatitis, coagulopathy, or an adjacent dilated pancreatic duct. 24 patients have undergone EUS-FNA, combined with ethanol lavage. Ethanol lavage was performed with dilute ethanol (5-80%) for 3-5 minutes and removed by aspiration. Cyst fluid was analyzed for cytology, amylase, and CEA. Patients were monitored for 2 hours after EUS and questioned regarding abdominal pain, nausea, and vomiting. All patients were contacted by phone at 48 hours and questioned regarding symptoms arising after the procedure. Results: Patient characteristics: Mean age (64yrs); Gender (19 females 5 males); Location (9 tail, 7 body, 8 head); Mean diameter (18.2mm) ; Mean wall thickness (1.6mm); Morphology (18 unilocular, 6 septated); Cyst fluid : mucoid (13/24), Mean CEA (2822 ng/ml), Mean amylase (15,001 U/ml), Cytology (mucinous-3, serous-2, inflamm-5, non-diagnostic-14). No patients developed abdominal pain, nausea, vomiting, or fever after the lavage (starting with 5% and increasing to 80% ethanol). 8 pts have undergone follow-up imaging. 5/8 pts have had resolution of the cystic lesion. 3/8 pts have a persistent cystic lesion (two patients with multiple cysts, one patient with a unilocular cyst). 3 patients (5%,40%,40% ethanol) have undergone resection. Surgical pathology demonstrated epithelial denudation without evidence of pancreatitis. Conclusions: EUS-guided ethanol lavage does not appear to cause pancreatitis or abdominal pain. Preliminary results suggest that it may be effective in cyst ablation.