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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(08): E1039-E1041
DOI: 10.1055/a-1196-1343
Case report

Pancreatitis kills cysts: A phenomenon that illustrates the potential role of immune activation in premalignant cyst ablation

Leonard T. Walsh
1   Penn State Health Milton S. Hershey Medical Center – Internal Medicine, Hershey, Pennsylvania, United States
,
Matthew T. Moyer
2   Penn State Health Milton S. Hershey Medical Center – Gastroenterology and Hepatology, Hershey, Pennsylvania, United States
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Abstract

Background and study aims Pancreatic cystic lesions are being increasingly recognized on cross-sectional imaging and mucinous premalignant cysts represent one of the most prevalent types. Endoscopic ultrasound (EUS)-guided chemoablation offers a safe and minimally invasive ablation approach yet with limited efficacy. Patients who develop acute pancreatitis as a complication of chemoablation with alcohol however experience ablation rates up to 100 %. This evidence suggests that recruitment of the body’s immune system may represent an avenue to significantly increase the efficacy of EUS-guided chemoablation. Here we illustrate this immune-mediated tumor killing phenomenon through a case presentation at our institution.



Publication History

Received: 19 September 2019

Accepted: 18 May 2020

Article published online:
21 July 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Moyer MT, Sharzehi S, Mathew A. et al. The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol. Gastroenterol 2017; 153: 1295-1303
    CrossrefPubMedSearch in Google Scholar
  • 2 Dewitt JM, McGreevy K, Schmidt CM. et al. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc 2009; 70: 710-723
    CrossrefPubMedSearch in Google Scholar
  • 3 Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc 2013; 77: 526-533
    CrossrefPubMedSearch in Google Scholar
  • 4 Oh HC, Seo DW, Lee TY. et al. New treatment for cystic tumors of the pancreas: EUS guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008; 67: 636-642
    CrossrefPubMedSearch in Google Scholar
  • 5 DeWitt J, DiMaio CJ, Brugge WR. Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation. Gastrointest Endosc 2010; 72: 862-866
    CrossrefPubMedSearch in Google Scholar
  • 6 Dewitt JM, Al-Haddad M, Sherman S. et al. Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel. Endoscopy 2014; 46: 457-464
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Torphy RJ, Zhu Y, Schulick RD. Immunotherapy for pancreatic cancer: Barriers and breakthroughs. Ann Gastroenterol Surg 2018; 2: 274-281
    CrossrefPubMedSearch in Google Scholar