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Long Term Outcomes After EUS-guided Ablation for Cystic Tumors of the Pancreas (EUS-EP)

This study is ongoing, but not recruiting participants.
Sponsor:
ClinicalTrials.gov Identifier:
NCT00689715
First Posted: June 4, 2008
Last Update Posted: July 26, 2016
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Dong Wan Seo, Asan Medical Center
June 2, 2008
June 4, 2008
July 26, 2016
June 2006
August 2016   (Final data collection date for primary outcome measure)
  • Incidence of adverse events Treatment response by change of calculated cyst volume [ Time Frame: early (< 7 days) and late (> 7days) adverse events ]
  • recurrence during follow up [ Time Frame: any recurrence of cyst after complete resolution during at least 3 years follow up ]
Incidence of complications Treatment response by change of calculated cyst volume [ Time Frame: 30-days for complication and at least 6 months for treatment response ]
Complete list of historical versions of study NCT00689715 on ClinicalTrials.gov Archive Site
  • treatment response [ Time Frame: 1 year ]
  • predictive factors for complete resolution [ Time Frame: 1 year ]
Not Provided
Not Provided
Not Provided
 
Long Term Outcomes After EUS-guided Ablation for Cystic Tumors of the Pancreas
Long Term Outcomes After EUS-guided Ablation for Cystic Tumors of the Pancreas

Cystic lesions of the pancreas are defined as round, fluid-filled structures within the pancreas detected by radiologic imaging. With widespread use of cross-sectional imaging modalities for various indications, such lesions are now detected in nearly 20% of abdominal imagings, with the majority discovered incidentally. These lesions encompass a wide spectrum of histopathologic entities and biologic behavior, ranging from benign to malignant. Substantial morphologic overlap restricts the accuracy in diagnosing specific type of cystic lesion in spite of recent advances in diagnostic modalities. It is a challenging issue to differentiate each cystic lesion and make a management plan since cystic lesions that are relatively common and asymptomatic may possess malignant potential. Although inflammatory pseudocysts were thought to account for 80-90% of cystic lesions of the pancreas, with cystic tumors accounting for the remaining,10 the latter may occur much more frequently than traditionally estimated.

To date, surgical resection is generally recommended for malignant and potentially malignant lesions. However, surgical resection of the pancreas still carries substantial morbidity and sometimes mortality, especially for the cystic lesion located in the head portion. Therefore, management should be individualized by risk-benefit analysis for each patient.

Recently, a pilot study of EUS-guided ethanol lavage for cystic tumors of the pancreas reported that complete resolution was achieved in only one-third of patients even though epithelial lining ablation was demonstrated in all resected specimens. Therefore, more effective treatment modalities or ablation agents are required to improve treatment responses. Intratumoral or intraperitoneal injection of chemotherapeutic agent has been used for endobronchial lesions of lung cancer, brain tumors and advanced ovarian cancer.13-16 EUS-guided injection of antitumor material has been reported in advanced pancreatic cancer. Although local injection of chemotherapeutic agents into pancreatic cystic tumors has not yet been reported, it is reasonable to suggest that such an approach may have an additive effect on ablation of the epithelial lining of cystic tumor when combined with ethanol lavage.

Paclitaxel, a widely used chemotherapeutic agent, inhibits cell processes that are dependent on microtubule turnover. Due to its highly hydrophobic nature,19 paclitaxel is expected to exert its effect longer when instilled within a closed cavity such as a cyst. The hydrophobic and viscous nature of paclitaxel may reduce the possibility of it leaking through a puncture site and causing complications.

The present study evaluated safety, feasibility and response following EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) for treating cystic tumors of the pancreas.

Not Provided
Interventional
Phase 2
Phase 3
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Cystic Tumors of the Pancreas
Procedure: Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection
A curvilinear-array echoendoscope and a 22 gauge needle were then used for cyst fluid aspiration, ethanol lavage and paclitaxel injection. The maximum possible volume of cyst fluid was aspirated, and the needle tip was carefully maintained inside the cyst to avoid parenchymal injury. Ethanol was injected into the collapsed cyst until the original shape was restored, and a lavage was then performed for 3-5 minutes. Pure ethanol (99%) was used for all patients except the first 2 in whom 88% ethanol was used. After reaspiration of the injected ethanol, the cyst cavity was injected with a solution containing 3 mg/mL paclitaxel and the needle then carefully retracted. The high viscosity of paclitaxel necessitated dilution in 0.9% normal saline for administration via a 22G needle. The volume of the paclitaxel solution administered was the same as the volume of the cyst fluid aspirated.
Other Name: paclitaxel (Taxol®, 6 mg/mL, Bristol-Myers Squibb Pharmaceutical Group)
Experimental: EP
Single treatment arm
Intervention: Procedure: Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection
Oh HC, Seo DW, Lee TY, Kim JY, Lee SS, Lee SK, Kim MH. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc. 2008 Apr;67(4):636-42. doi: 10.1016/j.gie.2007.09.038. Epub 2008 Feb 11.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
50
August 2016
August 2016   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • uni- or oligo-locular cystic tumors
  • indeterminate cystic tumors for which EUS-guided fine needle aspiration (FNA) was required to obtain additional information
  • cystic tumors that increased in size during the observation period

Exclusion Criteria:

  • cystic tumors which had the typical morphology of serous cystadenomas (i.e., honeycomb appearance) and pseudocysts (i.e., parenchymal changes)
  • evidence of communication between the cystic lesion and the main pancreatic duct according to endoscopic retrograde pancreatograms
  • overt carcinomas with peripancreatic invasion
  • patients with a bleeding tendency (prothrombin time > 1.5 international normalized ratio [INR] or platelet count < 50,000/μL).
Sexes Eligible for Study: All
20 Years to 85 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
Korea, Republic of
 
 
NCT00689715
AMC0183
Yes
Not Provided
Not Provided
Dong Wan Seo, Asan Medical Center
Asan Medical Center
Not Provided
Principal Investigator: Dong Wan Seo, M.D., Ph.D Asan Medical Center, University of Ulsan Collge of Medicine
Asan Medical Center
July 2016

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP