Post written by Matthew T. Moyer, MD, MS, FASGE, from Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

EUS-guided pancreatic cyst chemoablation is a rapidly developing, minimally invasive approach for treating appropriately selected mucinous pancreatic cysts. This article reviews best practices for this procedure including patient selection, setup, procedure performance, team structure, radiographic assessment, proper follow-up, and quality assurance issues.

Pancreatic cysts are common with the vast majority low risk. However, the natural history of an individual mucinous pancreatic cyst is variable with the overall risk of progression to pancreatic cancer generally linked to the number of identified high-risk features. Identification of a mucinous pancreatic cyst requires the clinician and patient to choose between indefinite radiographic surveillance (magnetic resonance imaging or CT) or therapy by surgical resection, which both have considerable limitations.

Surveillance for malignancy carries significant economic and likely psychological burdens. Conversely, surgical resection possesses the risk for serious adverse events (20%-40%) and mortality (1%-5%) and still requires postoperative surveillance.

In this respect, EUS-guided pancreatic cyst ablation has emerged as an innovative and promising minimally invasive approach for the treatment of appropriately selected pancreatic cysts (Fig. 1).

EUS-guided pancreatic cyst chemoablation is a specialized procedure and best used as part of a multidisciplinary program at high-volume centers with expertise in pancreaticobiliary disease. For these centers, this review illustrates the most important clinical pearls that we have learned conducting randomized prospective trials and off-protocol chemoablations with long-term follow-up.

For centers interested in developing their own pancreatic cyst chemoablation program, a more comprehensive instructional video can be viewed on GI Leap, the American Society for Gastrointestinal Endoscopy’s educational platform, at https://learn.asge.org/URL/EUSGuidedChemoablation.

The EUS-guided chemoablation process. After a full examination, the FNA needle is guided to the center of the cyst chamber where all of the mucinous fluid is aspirated, leaving a small rim of fluid around the needle tip for safety. The same volume of chemoablation admixture in then infused, reconstituting the cyst to its original size and dimensions.

Read the full article online.

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