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Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection
Kai Matthes1, Mari Mino-Kenudson, Dushyant V Sahani
1Gastrointestinal Unit, Gastrointestinal Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Background:
Ethanol is a commonly available agent and has been used to successfully and safely ablate cystic lesions of various organs.
Objective:
The aim of this study was to determine the short-term effects of an EUS-guided injection of ethanol into the pancreas of pigs by using 2 mL ethanol, in increasing concentration of 0% to 100%.
Design:
Six pigs were sedated by general anesthesia, and ethanol was injected, under EUS-guidance, with a 22-gauge needle into the pancreatic tail.
Main Outcome Measurements:
End points of this study were gross and microscopic evidence of pancreatitis and clinical tolerance. During the 7-day observational period, the animals were monitored by serum levels of amylase and lipase and by a CT on day 4.
Results:
At euthanasia, there was no pancreatic lesion in the animals that received normal saline solution or 20% ethanol. The injection of 40% to 100% ethanol led to a visible necrotic area in the pancreatic tail. By histology, the average maximal diameter of the lesions was 20.8 +/- 4.3 mm. The cross-sectional area of necrosis was proportional to the concentration of ethanol (r = 0.961). CT demonstrated a localized site of nonenhancing pancreatic tissue, with an average diameter of 19.4 +/- 10.5 mm; 40% to 100% ethanol. Clinically, the animals appeared to tolerate the procedure without sequelae. Serum levels of amylase and lipase were normal.
Conclusions:
The EUS-guided injection of ethanol into the pig pancreas resulted in a localized concentration-dependent tissue necrosis without complications.
