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Gastrointest Endosc. 2012 Dec;76(6):1142-51. doi: 10.1016/j.gie.2012.08.006. Epub 2012 Sep 26.

Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer.

Author information

1
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University-Scientific Institute San Raffaele, Milan, Italy. arcidiacono.paologiorgio@hsr.it

Abstract

BACKGROUND:

New therapies are needed for pancreatic cancer.

OBJECTIVE:

To determine the feasibility and safety of a new endoscopic treatment. Secondary endpoints were to determine effects on tumor growth measured with CT scan and to find the overall survival.

DESIGN:

A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance.

SETTING:

San Raffaele Hospital, Milan, Italy; University Medical Center, Hamburg-Eppendorf, Germany.

PATIENTS:

A total of 22 patients (male/female 11/11; mean age 61.9 years) were enrolled from September 2009 to May 2011.

INTERVENTION:

Radiofrequency heating: 18 W; pressure for cooling: 650 psi (Pounds per Square Inch); application time: depending on tumor size.

MAIN OUTCOME MEASUREMENTS:

Feasibility was evaluated during the procedure. A clinical and radiologic follow-up was planned.

RESULTS:

The CTP was successfully applied in 16 patients (72.8%); in 6 it was not possible because of stiffness of the GI wall and of the tumor. Amylase arose in 3 of 16 patients; none had clinical signs of pancreatitis. Late complications arose in 4 cases: 3 were mostly related to tumor progression. Median postablation survival time was 6 months. A CT scan was performed in all patients, but only in 6 of 16 was it possible to clearly define the tumor margins after ablation. In these patients, the tumor appeared smaller compared with the initial mass (P = .07).

LIMITATIONS:

Small sample of patients, difficulty of objectifying the size of the ablated zone by CT scan.

CONCLUSION:

EUS-guided CTP ablation is feasible and safe. Further investigations are needed to demonstrate progression-free survival and local control.

PMID:
23021160
DOI:
10.1016/j.gie.2012.08.006
[Indexed for MEDLINE]
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