Post written by Yun Je Song, MD, Gunn Huh, MD, and Do Hyun Park, MD, PhD, from the Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

The focus of our study was to compare the efficacy, safety, and oncologic outcomes of EUS-guided rapid ethanol lavage (EUS-REL) with surveillance only (SO) in the treatment of pancreatic cystic lesions (PCLs), including branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Our investigation aimed to explore EUS-REL’s role in achieving optimal ethanol concentrations in PCLs, its ability to minimize the risk of procedure-related pancreatitis, and its potential as an alternative treatment modality, especially for patients unsuitable for surgery.

Conducting this study was crucial as it aimed to address the growing need for minimally invasive yet effective treatment modalities for PCLs, particularly for patients where surgical options are suboptimal. By comparing EUS-REL with SO, we intended to offer a deeper insight into its clinical implications, safety, and efficacy in managing PCLs, including BD-IPMNs. There is a notable paucity of comprehensive research in this domain, and our study serves as a pivotal step toward optimizing treatment strategies and improving patient outcomes in pancreatic conditions associated with a high risk of malignancy.

Our study found that EUS-REL achieved a complete response in 74% of EUS-REL-treated cysts with a considerably lower incidence rate of BD-IPMN progression, suggesting its potential oncologic benefits for select patients with PCLs. The results indicate that EUS-REL may be a viable and relatively safe alternative, especially for those with enlarging PCLs or those not optimal for surgery.

This study adds significant insight into the ongoing discourse on PCL management strategies by highlighting the comparative advantages of EUS-REL over SO. It extends the understanding of the benefits of achieving optimal ethanol concentrations in smaller pancreatic cysts through EUS-REL, thus paving the way for more refined and targeted treatment approaches.

Given the limitations of our study, such as its retrospective design and conduction at a single center, future research should involve larger multicenter studies with long-term follow-up to validate our findings. Investigations also should explore the incorporation of other agents in EUS-REL and evaluate its efficacy, focusing on the refinement of preprocedural diagnostic modalities and optimal candidate selection for EUS-guided ethanol ablation in patients with BD-IPMNs.

Our research is a seminal exploration in the field of pancreatic conditions associated with high malignancy risks, aiming to provoke thought and encourage studies in developing minimally invasive treatment modalities. We hope that our findings ignite more rigorous scientific inquiries and clinical innovations in the management of PCLs, including BD-IPMNs, ultimately contributing to enhanced clinical practices and improved patient outcomes.

The cumulative incidence of intraductal papillary mucinous neoplasm (IPMN) progression in patients with presumed IPMNs after matching. A, P = .003 by log-rank test and the cumulative incidence of IPMN progression among patients with pancreatic cystic lesions without categorizing cysts after matching. B, P = .008 by log-rank test. EUS-REL, EUS-guided rapid ethanol lavage; SO, surveillance only.

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