Endoscopic ultrasonography (EUS) has evolved into a useful therapeutic tool for treating a broad range of tumors since being introduced into clinical practice as a diagnostic modality nearly three decades ago. In part...Endoscopic ultrasonography (EUS) has evolved into a useful therapeutic tool for treating a broad range of tumors since being introduced into clinical practice as a diagnostic modality nearly three decades ago. In particular, EUS-guided fine-needle injection has proven a successful minimally invasive approach for treating benign lesions such as pancreatic cysts, relieving pancreatic pain through celiac plexus neurolysis, and controlling local tumor growth of unresectable malignancies by direct delivery of anti-tumor agents. One such ablative agent, ethanol, is capable of safely ablating solid or cystic lesions in hepatic tissues via percutaneous injection. Recent research and clinical interest has focused on the promise of EUS-guided ethanol ablation as a safe and effective method for treating pancreatic tumor patients with small lesions or who are poor operative candidates. Although it is not likely to replace radical resection of localized lesions or systemic treatment of metastatic tumors in all patients, EUS-guided ablation is an ideal method for patients who refuse or are not eligible for surgery. Moreover, this treatment modalitymay play an active role in the development of future pancreatic tumor treatments. This article reviews the most recent clinical applications of EUS-guided ethanol ablation in humans for treating pancreatic cystic tumors, pancreatic neuroendocrine tumors, and metastatic lesions.展开更多
AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an i...AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an injection of 10 mL of 0.25%Lidocaine plus methylene blue(group 1) and three received an injection of 10 mL of 0.25%Lidocaine plus blue colored poloxamer(PS137-25)(group 2) .Necropsy was performed immediately after the animals were sacrificed.The abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored poloxamer.RESULTS:EUS-guided CPN was successfully performed in all 6 pigs without immediate complication.Methylene blue was identified throughout the peritoneal and retroperitoneal cavity in group 1.The blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta,in the exact location of the celiac plexus in group 2.CONCLUSION:EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically feasible.The presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.展开更多
Background and Aims: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Though they require multispecialty support;role of endos...Background and Aims: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Though they require multispecialty support;role of endoscopic interventions in palliation is paramount because of the advancement in technology and increase experience of Gastroenterologist. Methods: We did extensive review of articles regarding endoscopic advances in the management of Unresectable Periampullary Malignancies. Several systematic reviews, Meta analysis, and Randomized controlled trials published over the last 2 decades were thoroughly searched on PUBMED and GOOGLE SCHOLAR. Results: Advanced Endoscopic procedures have been emerging as a superior modality than conventional measures because of minimal invasiveness and greater clinical and technical success. Conclusion: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Several endoscopic interventions have already been established as the standard of care in palliation of symptoms of unresectable periampullary malignancies, we can say with confidence that with growing advances in EUS, advancement in technologies and increasing experiences, the role of gastroenterologist will be pivotal in these groups of patients.展开更多
Celiac plexus neurolysis (CPN) has become a minimally invasive approach for the management of patients with unresectable pancreatic cancer and abdominal pain unresponsive to medical treatment. CPN has been shown to ha...Celiac plexus neurolysis (CPN) has become a minimally invasive approach for the management of patients with unresectable pancreatic cancer and abdominal pain unresponsive to medical treatment. CPN has been shown to have long-lasting improvement in abdominal pain and decreased narcotic usage in 70% to 90% of patients. Therefore, the aim of this paper was to report our experience with CPN in the treatment of two cases of advanced pancreatic cancer, with satisfying results in controlling pain. The use of CT scan-guided CPN should be considered and performed relatively early in the course of disease to offer optimal pain relief and increase the patient’s quality of life.展开更多
For the first several years after its development,endoscopic ultrasound(EUS) was primarily limited to identification of pancreatic malignancies. Since this time, the field of EUS has advanced at a tremendous speed in ...For the first several years after its development,endoscopic ultrasound(EUS) was primarily limited to identification of pancreatic malignancies. Since this time, the field of EUS has advanced at a tremendous speed in terms of additional clinical diagnostic and therapeutic uses. The combination of ultrasound with endoscopy provides a unique interventional modality that is a minimally invasive alternative to various surgical interventions. Given the expanding recommended indications for EUS, this article will serve to review the most common uses with supporting evidence, while also exploring innovative endeavors that may soon become common clinical practice.展开更多
基金Supported by A grant from the Shanghai Science and Technology Committee Foundation, No. 11D21921605
文摘Endoscopic ultrasonography (EUS) has evolved into a useful therapeutic tool for treating a broad range of tumors since being introduced into clinical practice as a diagnostic modality nearly three decades ago. In particular, EUS-guided fine-needle injection has proven a successful minimally invasive approach for treating benign lesions such as pancreatic cysts, relieving pancreatic pain through celiac plexus neurolysis, and controlling local tumor growth of unresectable malignancies by direct delivery of anti-tumor agents. One such ablative agent, ethanol, is capable of safely ablating solid or cystic lesions in hepatic tissues via percutaneous injection. Recent research and clinical interest has focused on the promise of EUS-guided ethanol ablation as a safe and effective method for treating pancreatic tumor patients with small lesions or who are poor operative candidates. Although it is not likely to replace radical resection of localized lesions or systemic treatment of metastatic tumors in all patients, EUS-guided ablation is an ideal method for patients who refuse or are not eligible for surgery. Moreover, this treatment modalitymay play an active role in the development of future pancreatic tumor treatments. This article reviews the most recent clinical applications of EUS-guided ethanol ablation in humans for treating pancreatic cystic tumors, pancreatic neuroendocrine tumors, and metastatic lesions.
基金Supported by A grant from Generalitat de Catalunya(AGAUR,BE-100022)
文摘AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided CPN.Three received an injection of 10 mL of 0.25%Lidocaine plus methylene blue(group 1) and three received an injection of 10 mL of 0.25%Lidocaine plus blue colored poloxamer(PS137-25)(group 2) .Necropsy was performed immediately after the animals were sacrificed.The abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored poloxamer.RESULTS:EUS-guided CPN was successfully performed in all 6 pigs without immediate complication.Methylene blue was identified throughout the peritoneal and retroperitoneal cavity in group 1.The blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta,in the exact location of the celiac plexus in group 2.CONCLUSION:EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically feasible.The presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.
文摘Background and Aims: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Though they require multispecialty support;role of endoscopic interventions in palliation is paramount because of the advancement in technology and increase experience of Gastroenterologist. Methods: We did extensive review of articles regarding endoscopic advances in the management of Unresectable Periampullary Malignancies. Several systematic reviews, Meta analysis, and Randomized controlled trials published over the last 2 decades were thoroughly searched on PUBMED and GOOGLE SCHOLAR. Results: Advanced Endoscopic procedures have been emerging as a superior modality than conventional measures because of minimal invasiveness and greater clinical and technical success. Conclusion: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Several endoscopic interventions have already been established as the standard of care in palliation of symptoms of unresectable periampullary malignancies, we can say with confidence that with growing advances in EUS, advancement in technologies and increasing experiences, the role of gastroenterologist will be pivotal in these groups of patients.
文摘Celiac plexus neurolysis (CPN) has become a minimally invasive approach for the management of patients with unresectable pancreatic cancer and abdominal pain unresponsive to medical treatment. CPN has been shown to have long-lasting improvement in abdominal pain and decreased narcotic usage in 70% to 90% of patients. Therefore, the aim of this paper was to report our experience with CPN in the treatment of two cases of advanced pancreatic cancer, with satisfying results in controlling pain. The use of CT scan-guided CPN should be considered and performed relatively early in the course of disease to offer optimal pain relief and increase the patient’s quality of life.
文摘For the first several years after its development,endoscopic ultrasound(EUS) was primarily limited to identification of pancreatic malignancies. Since this time, the field of EUS has advanced at a tremendous speed in terms of additional clinical diagnostic and therapeutic uses. The combination of ultrasound with endoscopy provides a unique interventional modality that is a minimally invasive alternative to various surgical interventions. Given the expanding recommended indications for EUS, this article will serve to review the most common uses with supporting evidence, while also exploring innovative endeavors that may soon become common clinical practice.
