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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(07): E861-E867
DOI: 10.1055/a-2286-1995
Original article

EUS-guided hydrogel injection to separate pancreatic head carcinoma from duodenum for enhanced radiotherapy: Multi-site feasibility study

Manoop S. Bhutani
1   Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, United States (Ringgold ID: RIN4002)
,
Amol K. Narang
2   Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, United States (Ringgold ID: RIN1466)
,
Kai Ding
2   Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, United States (Ringgold ID: RIN1466)
,
Brenna Casey
3   Interventional Gastroenterology, Massachusetts General Hospital Harvard Medical School, Boston, United States (Ringgold ID: RIN1855)
,
Kumar Krishnan
4   Gastroenterology, Massachusetts General Hospital, Boston, United States (Ringgold ID: RIN2348)
,
Eugene J. Koay
5   Department of GI Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, United States (Ringgold ID: RIN4002)
,
Theodore S. Hong
6   Radiation Oncology, Massachusetts General Hospital, Boston, United States (Ringgold ID: RIN2348)
,
Joseph M. Herman
7   Department of Radiation Medicine, Northwell, New Hyde Park, United States (Ringgold ID: RIN5799)
,
Kristen H. Griffin
8   Urology, Boston Scientific Corp, Marlborough, United States (Ringgold ID: RIN5724)
,
Eun Ji Shin
9   Internal Medicine, Johns Hopkins Medicine, Baltimore, United States (Ringgold ID: RIN1501)
› Author AffiliationsSupported by: Boston Scientific Corporation

Clinical Trial: Registration number (trial ID): NCT03998566, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Multi-Center Feasibility Study
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Abstract

Background and study aims The proximity of a pancreas head tumor to the duodenum often limits delivery of an ablative dose of radiation therapy. This study evaluated the feasibility and safety of using an injectable polyethylene glycol (PEG) hydrogel between the head of the pancreas and duodenum.

Patients and methods In a multi-site feasibility cohort study of patients with localized pancreatic cancer, PEG hydrogel was injected under endoscopic ultrasound guidance to temporarily position the duodenum away from the pancreas. Procedure characteristics were recorded, including hydrogel volume and space created. Patients were monitored for adverse events (AEs) and radiotherapy toxicity.

Results In all six intent-to-treat patients (four with borderline resectable, two with locally advanced disease), the ability to place and visualize PEG hydrogel and create space between the duodenum and the head of the pancreas was successful. There were no procedure-related AEs resulting in radiotherapy delay. There were no device-related AEs and no reports of pancreatitis.

Conclusions PEG hydrogel was successfully placed, created space between the duodenum and the head of the pancreas, and was not associated with major toxicity. Enhancing radiotherapy for pancreatic cancer by using PEG hydrogel to create peri-duodenal space could have beneficial implications for treatment and warrants more exploration.

Keywords

Endoscopic ultrasonography - Pancreas - Interventional EUS - Fine-needle aspiration/biopsy

Supplementary Material



Publication History

Received: 15 November 2023

Accepted after revision: 21 March 2024

Accepted Manuscript online:
25 March 2024

Article published online:
10 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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