EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Oncology

Background:

• Pancreatic cyst surgery carries significant morbidity.
• Endoscopic ultrasound (EUS)-guided ethanol lavage has shown promise in pilot studies for pancreatic cyst management.
• Evaluating EUS-guided ethanol lavage as a less invasive treatment option is crucial.

Purpose of the Study:

• To compare the efficacy of EUS-guided ethanol lavage versus saline solution lavage in reducing pancreatic cyst size.
• To assess the safety and effectiveness of repeat ethanol lavage procedures.

Main Methods:

• Prospective, multicenter, randomized trial involving patients with 1- to 5-cm unilocular pancreatic cysts.
• Patients were randomized to blinded EUS-guided ethanol or saline solution lavage.
• Cyst size was reassessed after three months, followed by an optional second ethanol lavage.

Main Results:

• Ethanol lavage achieved a significantly greater mean percentage decrease in cyst surface area (-42.9%) compared to saline solution (-11.4%).
• Complete cyst resolution on CT scan was observed in 33.3% of cases.
• Histology confirmed epithelial ablation in 50% to 100% of cysts treated with ethanol lavage, with similar complication rates across groups.

Conclusions:

• EUS-guided ethanol lavage is more effective than saline solution lavage in reducing pancreatic cyst size.
• The procedure demonstrates a favorable safety profile, comparable to saline lavage.
• CT-defined complete pancreatic cyst ablation was achieved in 33.3% of patients, warranting further investigation.