Endoscopic diagnosis and treatment of pancreatic cystic lesions
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摘要:
随着影像学技术的进展,胰腺囊性病变诊断率逐年增高。胰腺囊性病变是一组异质性的疾病,主要包括导管内乳头状黏液肿瘤、黏液性囊性肿瘤、浆液性囊性肿瘤和其他罕见的囊性病变,不同类型的胰腺囊性肿瘤具有不同的生物学行为,恶变率也完全不同。对胰腺囊性肿瘤患者进行精准诊断,进而决定部分患者行手术治疗,而另一部分患者可行随访观察。超声内镜和超声内镜引导下细针穿刺囊液分析对胰腺囊性疾病的诊断和鉴别诊断发挥着重要作用。超声内镜引导下的胰腺囊性疾病消融治疗,虽然已经开展了十多年,仍处于起步阶段。但该手术安全有效,可作为外科手术的替代疗法,是一项颇具前景的治疗手段。
Abstract:The diagnostic rate of pancreatic cystic lesions(PCLs) is increasing year by year with the development of radiological techniques.PCLs are a group of heterogeneous diseases,mainly including intraductal papillary mucinous neoplasms,mucinous cystic neoplasm,serous cystic neoplasm,and other rare cystic lesions,and different types of pancreatic cystic neoplasms have different biological behaviors and rates of malignant transformation.A precise diagnosis of patients with pancreatic cystic neoplasms helps to select surgical treatment for some patients and perform follow-up observation for other patients.Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration play an important role in the diagnosis and differential diagnosis of PCLs.Endoscopic ultrasound-guided ablation therapy for PCLs is still in the early stage although it has been performed for more than a decade;however,it is safe and effective and can be used as an substitutive therapy for surgical operation,and therefore,it holds promise for clinical application.
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Key words:
- pancreatic cystic neoplasms /
- endoscopic ultrasonography /
- diagnosis /
- therapeutics
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[1] de JONG K,NIO CY,HERMANS JJ,et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations[J]. Clin Gastroenterol Hepatol,2010,8(9):806-811. [2] SUN L,WANG Y,JIANG F,et al. Prevalence of pancreatic cystic lesions detected by magnetic resonance imaging in the Chinese population[J]. J Gastroenterol Hepatol,2019,34(9):1656-1662. [3] AHMAD NA,KOCHMAN ML,BRENSINGER C,et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions[J]. Gastrointest Endosc,2003,58(1):59-64. [4] SCHEIMAN JM,HWANG JH,MOAYYEDI P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts[J].Gastroenterology,2015,148(4):824-848. [5] MORIS M,BRIDGES MD,POOLEY RA,et al. Association between advances in high-resolution cross-section imaging technologies and increase in prevalence of pancreatic cysts from 2005 to 2014[J]. Clin Gastroenterol Hepatol,2016,14(4):585-593. [6] YAMASHITA Y,UEDA K,ITONAGA M,et al. Usefulness of contrast-enhanced endoscopic sonography for discriminating mural nodules from mucous clots in intraductal papillary mucinous neoplasms:A single-center prospective study[J]. J Ultrasound Med,2013,32(1):61-68. [7] FUSAROLI P,SERRANI M,de GIORGIO R,et al. Contrast harmonic-endoscopic ultrasound is useful to identify neoplastic features of pancreatic cysts(with videos)[J]. Pancreas,2016,45(2):265-268. [8] BICK BL,ENDERS FT,LEVY MJ,et al. The string sign for diagnosis of mucinous pancreatic cysts[J]. Endoscopy,2015,47(7):626-631. [9] THOSANI N,THOSANI S,QIAO W,et al. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions:A systematic review and meta-analysis[J].Dig Dis Sci,2010,55(10):2756-2766. [10] PITMAN MB,GENEVAY M,YAEGER K,et al. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than“positive”cytology[J]. Cancer Cytopathol,2010,118(6):434-440. [11] HONG SK,LOREN DE,ROGART JN,et al. Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts[J]. Gastrointest Endosc,2012,75(4):775-782. [12] BASAR O,YUKSEL O,YANG D,et al. The micro-forceps for pancreatic cysts a game changer[J]. Pancreas,2016,45:1494-1551. [13] van der WAAIJ LA,van DULLEMEN HM,PORTE RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions:A pooled analysis[J]. Gastrointest Endosc,2005,62(3):383-389. [14] RYU JK,WOO SM,HWANG JH,et al. Cyst fluid analysis for the differential diagnosis of pancreatic cysts[J]. Diagn Cytopathol,2004,31(2):100-105. [15] MAIRE F,COUVELARD A,HAMMEL P,et al. Intraductal papillary mucinous tumors of the pancreas:The preoperative value of cytologic and histopathologic diagnosis[J]. Gastrointest Endosc,2003,58(5):701-706. [16] SOYER OM,BARAN B,ORMECI AC,et al. Role of biochemistry and cytological analysis of cyst fluid for the differential diagnosis of pancreatic cysts:A retrospective cohort study[J].Medicine(Baltimore),2017,96(1):e5513. [17] WANG W,ZHANG L,CHEN L,et al. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 for prediction of malignancy and invasiveness in intraductal papillary mucinous neoplasms of the pancreas:A meta-analysis[J]. Biomed Rep,2015,3(1):43-50. [18] TAKAORI K.“Revisions of the International Consensus Fukuoka Guidelines for the Management of IPMN of the Pancreas”:Progress for twelve years[J]. Pancreatology,2017,17(5):645-646. [19] KULZER M,SINGHI AD,FURLAN A,et al. Current concepts in molecular genetics and management guidelines for pancreatic cystic neoplasms:An essential update for radiologists[J]. Abdom Radiol(NY),2018,43(9):2351-2368. [20] MAJUMDER S,TAYLOR WR,YAB TC,et al. Novel methylated DNA markers discriminate advanced neoplasia in pancreatic cysts:Marker discovery,tissue validation,and cyst fluid testing[J]. Am J Gastroenterol,2019,114(9):1539-1549. [21] WANG L,ZHENG J,SUN C,et al. MicroRNA expression levels as diagnostic biomarkers for intraductal papillary mucinous neoplasm[J]. Oncotarget,2017,8(35):58765-58770. [22] JABBAR KS,ARIKE L,VERBEKE CS,et al. Highly accurate identification of cystic precursor lesions of pancreatic cancer through targeted mass spectrometry:A phase IIc diagnostic study[J]. J Clin Oncol,2018,36(4):367-375. [23] KONDA VJ,MEINING A,JAMIL LH,et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needlebased confocal laser endomicroscopy under endosonographic guidance[J]. Endoscopy,2013,45(12):1006-1013. [24] NAPOLEON B,LEMAISTRE AI,PUJOL B,et al. In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy(n CLE):Proposition of a comprehensive n CLE classification confirmed by an external retrospective evaluation[J]. Surg Endosc,2016,30(6):2603-2612. [25] YANG D,TRINDADE AJ,YACHIMSKI P,et al. Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts[J]. Clin Gastroenterol Hepatol,2019,17(8):1587-1596. [26] BARRESI L,CRINSF,FABBRI C,et al. Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions:A multicenter study[J]. Dig Endosc,2018,30(6):760-770. [27] YANG D,SAMARASENA JB,JAMIL LH,et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions:A multicenter study[J]. Endosc Int Open,2018,6(12):e1423-e1430. [28] MITTAL C,OBUCH JC,HAMMAD H,et al. Technical feasibility,diagnostic yield,and safety of microforceps biopsies during EUS evaluation of pancreatic cystic lesions(with video)[J]. Gastrointest Endosc,2018,87(5):1263-1269. [29] BASAR O,YUKSEL O,YANG DJ,et al. Feasibility and safety of microforceps biopsy in the diagnosis of pancreatic cysts[J]. Gastrointest Endosc,2018,88(1):79-86. [30] TEOH AY,SEO DW,BRUGGE W,et al. Position statement on EUS-guided ablation of pancreatic cystic neoplasms from an international expert panel[J]. Endosc Int Open,2019,7(9):e1064-e1077. [31] ELTA GH,ENESTVEDT BK,SAUER BG,et al. ACG clinical guideline:Diagnosis and management of pancreatic cysts[J]. Am J Gastroenterol,2018,113(4):464-479. [32] OFOSU A,RAMAI D,ADLER DG. Endoscopic ultrasoundguided ablation of pancreatic cystic neoplasms:Ready for prime time?[J]. Ann Gastroenterol,2019,32(1):39-45. [33] OH HC,BRUGGE WR. EUS-guided pancreatic cyst ablation:A critical review(with video)[J]. Gastrointest Endosc,2013,77(4):526-533. [34] SIGNORETTI M,VALENTE R,REPICI A,et al. Endoscopyguided ablation of pancreatic lesions:Technical possibilities and clinical outlook[J]. World J Gastrointest Endosc,2017,9(2):41-54. [35] KANDULA M,MOOLE H,CASHMAN M,et al. Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts:A meta-analysis and systematic review[J]. Indian J Gastroenterol,2015,34(3):193-199. [36] GAN SI,THOMPSON CC,LAUWERS GY,et al. Ethanol lavage of pancreatic cystic lesions:Initial pilot study[J]. Gastrointest Endosc,2005,61(6):746-752. [37] DEWITT JM,AL-HADDAD M,SHERMAN S,et al. Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel[J]. Endoscopy,2014,46(6):457-464. [38] PARK JK,SONG BJ,RYU JK,et al. Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation[J]. Pancreas,2016,45(6):889-894. [39] GMEZ V,TAKAHASHI N,LEVY MJ,et al. EUS-guided ethanol lavage does not reliably ablate pancreatic cystic neoplasms(with video)[J]. Gastrointest Endosc,2016,83(5):914-920. [40] CAILLOL F,POINCLOUX L,BORIES E,et al. Ethanol lavage of14 mucinous cysts of the pancreas:A retrospective study in two tertiary centers[J]. Endosc Ultrasound,2012,1(1):48-52. [41] PARK JK,SONG BJ,RYU JK,et al. Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation[J]. Pancreas,2016,45(6):889-894. [42] ATTILA T,ADSAY V,FAIGEL DO. The efficacy and safety of endoscopic ultrasound-guided ablation of pancreatic cysts with alcohol and paclitaxel:A systematic review[J]. Eur J Gastroenterol Hepatol,2019,31(1):1-9. [43] OH HC,SEO DW,LEE TY,et al. New treatment for cystic tumors of the pancreas:EUS-guided ethanol lavage with paclitaxel injection[J]. Gastrointest Endosc,2008,67(4):636-642. [44] OH HC,SEO DW,SONG TJ,et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts[J]. Gastroenterology,2011,140(1):172-179. [45] MOYER MT,DYE CE,SHARZEHI S,et al. Is alcohol required for effective pancreatic cyst ablation? The prospective randomized CHARM trial pilot study[J]. Endosc Int Open,2016,4(5):e603-e607. [46] MOYER MT,SHARZEHI S,MATHEW A,et al. The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol[J]. Gastroenterology,2017,153(5):1295-1303. [47] LINGHU E,DU C,CHAI N,et al. A prospective study on the safety and effectiveness of using lauromacrogol for ablation of pancreatic cystic neoplasms with the aid of EUS[J]. Gastrointest Endosc,2017,86(5):872-880. [48] PAI M,HABIB N,SENTURK H,et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors[J]. World J Gastrointest Surg,2015,7(4):52-59. [49] BARTHET M,GIOVANNINI M,LESAVRE N,et al. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms:A prospective multicenter study[J]. Endoscopy,2019,51(9):836-842.
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