Post written by J. Westley Heinle, MPH, from the the Division of Gastroenterology and Hepatology, Penn State College of Medicine and Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.

The 2 randomized prospective Chemotherapy for Ablation and Resolution of Mucinous Pancreatic Cysts (ChARM) clinical trials investigate and develop alcohol-free EUS-guided pancreatic cyst chemoablation. The current investigation was centered on 3 key measured outcomes:

• Evaluate the long-term treatment durability and clinical outcomes of patients with mucinous pancreatic cysts treated with EUS-guided chemoablation as part of ChARM I or ChARM II randomized controlled trials.
• Evaluate the outcomes of the ChARM Post-treatment Reduced Radiographic Surveillance Protocol used after ChARM EUS-guided chemoablation and compare the cost of this strategy with matched, hypothetical patients who would have otherwise continued (without ablation) under high-risk surveillance as per accepted surveillance guidelines.
• Evaluate the patient perspective on pancreatic cyst surveillance and understand that perspective on how he or she would feel about a proposed reduction in radiographic surveillance after successful EUS-guided chemoablation (if such a reduction were possible).  

Mucinous pancreatic cysts are common and carry a significant potential for malignant transformation. EUS-guided chemoablation represents a minimally invasive treatment option for appropriately selected mucinous cysts. However, it is important to understand if successfully treated mucinous cysts remain clinically resolved, or if they recur at a significant rate.

In addition, if radiographic surveillance can be safely reduced after successful chemoablation, this would represent a significant financial and logistical relief for those patients. Further, we felt the need to investigate our treatment approach compared with current guidelines while seeking firsthand patient opinions regarding these issues. 

Our randomized prospective data with long-term follow-up after EUS-guided chemoablation demonstrates the durability of this procedure. In fact, we found that 30% of patients showed a delayed treatment effect with some with partial or nonresponses progressing to more complete ablation long term. Successful EUS-guided ablation allows a significant reduction in post-treatment magnetic resonance imaging (MRI) surveillance using the ChARM Post-treatment Reduced Radiographic Surveillance Protocol. This reduction in radiographic surveillance represents a significant cost savings to the patient and medical community. 

Lastly, patients report moderate dislike of MRI surveillance. Some clearly dislike the MRI itself, and the majority surveyed are in favor of a reduction in surveillance if it can be performed safely. 

Long-term follow-up of the randomized prospective ChARM and ChARM II trials showing the durability of EUS-guided chemoablation. Shown are the volume calculations from baseline to long-term follow-up after EUS-guided chemoablation treatment using a mixture of gemcitabine + paclitaxel.

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