EUS-Guided Pancreatic Cyst Ablation

Pancreatic cystic lesions consist of inflammatory pseudocysts and neoplastic lesions. Mucinous cystic lesions pose a risk of malignant degeneration. Although the natural history has not been well defined, it is likely that malignant change in the epithelium takes place over years. The traditional therapy of mucinous cystic lesions has been surgical resection. Lesions in the head of the pancreas will require a Whipple resection, whereas tail lesions are managed with a distal pancreatectomy and splenectomy. In patients at high risk for surgical resection, the risk/benefit ratio may be excessively high, not supporting the use of resection therapy. Ethanol ablation therapy has been thoroughly studied in hepatic, renal, and thyroid cysts. Epithelial ablation with ethanol appears to be highly effective and relatively safe. Recently, ethanol ablation has been evaluated in pancreatic cystic neoplasms. In macrocystic lesions between 1 and 5 cm, ethanol lavage will result in epithelial ablation and cyst resolution in a high percentage of patients. Pancreatitis is rarely observed clinically and is not present in resection specimens. A randomized prospective clinical trial is currently underway.