Endoscopic Ultrasound-Lavage Technique for Pancreatic Cancer: An In Vivo Pilot Study.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Imaging

Background:

• Pancreatic cancer (PC) has a dismal prognosis and low survival rate.
• Current imaging like CT/MRI may miss small peritoneal metastases, leading to unnecessary surgeries.
• Staging laparoscopy (SL) is invasive and resource-intensive, despite detecting occult disease in 20-30% of patients.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel endoscopic ultrasound-guided lavage (EUS-LT) technique.
• To determine if EUS-LT can enhance the accuracy of peritoneal staging in pancreatic cancer.
• To explore EUS-LT as an alternative to invasive staging procedures like SL.

Main Methods:

• The study utilized ten in vivo porcine models for EUS-LT.
• Saline was instilled into the intraperitoneal cavity via EUS-guided fine-needle aspiration (FNA) needle and subsequently recovered.
• Sequential refinements included an ENBD catheter with side holes and a side-hole introducer (EndoSheather).

Main Results:

• All ten procedures were technically successful, demonstrating feasibility.
• The average procedure time was 31.1 minutes, with refinements reducing procedure and infusion times.
• Minor mucosal injury was the only complication, resolving spontaneously; recovered volumes approached instilled amounts, indicating efficient lavage.

Conclusions:

• EUS-LT is technically feasible and demonstrated short-term safety in an in vivo porcine model.
• This technique has the potential to improve staging accuracy for pancreatic cancer.
• EUS-LT may offer a less invasive alternative for detecting peritoneal disease, potentially avoiding unnecessary surgeries.