Abstract
Introduction: With the development of imaging techniques, small pancreatic cystic neoplasms some of which exist possibility of malignancy are becoming more and more prevelant. Surgical morbidity and mortality rates for pancreatic cystic tumors are quitely high. There have been some studies on EUS-guided ethanol lavage therapy with or without paclitaxel injection for pancreatic cystic neoplasms, but lauromacrogol ablation have not been reported.We aim to evaluate the safety and effectiveness of EUSguided small pancreatic cystic neoplasms ablation with lauromacrogol. Methods: From April 2015 to may 2016,120 patients of small pancreatic cystic neoplasms were enrolled to perform EUS,among whom 59 patients finally received surgery.We prospectively studied 29 patients undergoing EUS-guided ablation with lauromacrogol among 120 patients. The follow-up pancreatic enhanced CT or MRI was taken at 3 months and then 6 months after frist ablation. We determined the efficiency of ablation by RECIST criteria. Results: Twenty women and nine men were enrolled in study and 7 of 29 patients underwent the second ablation so there are 36 cases of ablation. Twenty-one cases were located in the head/uncinate of the pancreas while 8 in the body/tail. Mean tumor diameter was 30mm(rang 11-72mm) pre operation while 14.1mm(rang 0-35mm) post. The mean volume of injected polidocanol was 10.9ml(rang 1.5-30ml). Mild pancreatitis occurred in 2 cases and moderate fever occurred in 1 case among 36 cases and all of these complications occurred in the cysts located in the head/uncinate.None of the patients reported any severe complications. Of the 23 cases with complete followed-up of 3.9 months(rang 1.5-12months),4 cases had complete resolution and 13 cases had partial resolution and the resolution rate is 73.9%. Complete resolution was achieved in 3 cases and partial resolution in 9 in the cysts of the head/uncinate, while 1 patient achieved complete resolution and 4 achieved partial resolution in the cysts of the body/tail. No statistically significant difference in resolution rate of the cysts was found between he head/uncinate and the body/tail(12/17vs5/6:P>0.05). Conclusion: EUS-guided small pancreatic cystic neoplasms ablation with lauromacrogol is safe and efficient. Complication rates were higher in the cysts of the head/uncinate than body/tail, but their resolution rates were similar. Further studies involving larger populations and longer follow-ups are warranted.Figure 1Figure 2
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