Introduction to Cyst Ablation

With the increasing detection of pancreatic cysts, many centers have applied endoscopic ultrasound‐guided pancreatic cyst ablation (EUS‐PCA), even in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas based on early promising outcomes.

Endoscopic ultrasound (EUS)-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens are investigative modalities.

Background and aim  Recently, several guidelines with divergent recommendations on management of pancreatic cystic neoplasm have been published but the role of endoscopic ultrasound (EUS)-guided pancreatic cyst ablation has not been thoroughly addressed.

The development and use of EUS cyst ablation is a minimally invasive alternative in treating pancreatic cystic lesions (PCLs).

The goal of this paper is to review the rationale for cyst ablation and discuss prior and current research on cyst ablation techniques and efficacy.

We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

Recent advances have expanded the utility of the procedure to therapeutic applications that include drainage of pancreatic fluid collections, abscesses and the gallbladder, celiac nerve block and neurolysis, cyst ablation, directed antitumoral injection, and enteroenteral anastomosis.

EUS-guided pancreatic cyst ablation has been investigated in a variety of clinical studies.

The recent ChARM trial demonstrated that removing ethanol from the cyst ablation process resulted in equivalent efficacy while significantly reducing associated AEs.