EUS-guided lauromacrogol ablation with different concentrations of lauromacrogol for the treatment of pancreatic cystic neoplasm: A randomized controlled study

Abstract

Objectives: To explore the safety and efficacy of injections of 1%, 2%, or 3% lauromacrogol during EUS-guided lauromacrogol ablation (EUS-LA) for the treatment of pancreatic cystic neoplasms (PCNs) and to determine the optimal concentration of lauromacrogol for use in EUS-LA therapeutic regimens.

Methods: From May 2021 to January 2023, patients who met the indications for EUS-LA were randomly divided into 3 groups: A, B, and C; the patients in these groups were injected with 1%, 2%, and 3% lauromacrogol during EUS-LA, respectively. Safety was evaluated based on the incidence of postoperative complications. Efficacy was comprehensively evaluated by assessing the ablation rate and ablation effect.

Results: Forty-two patients underwent EUS-LA, and 31 patients completed at least 1 postoperative re-examination. No acute pancreatitis was observed in the 1% and 2% lauromacrogol groups, and 1 case of acute pancreatitis occurred in the 3% lauromacrogol group. The total complication rate was 2.4%. The median ablation rates of the groups were 94.1%, 82.0%, and 100.0%, respectively. There were statistically significant differences in the EUS-LA ablation rate between the 1% and 3% lauromacrogol groups and between the 2% and 3% lauromacrogol groups. There was a statistically significant difference in complete disappearance between the 1% and 3% lauromacrogol groups as well as between the 2% and 3% lauromacrogol groups.

Conclusion: The short-term outcomes showed that injections of 1%, 2%, and 3% lauromacrogol were safe for use in EUS-LA, and injection of 3% lauromacrogol was the most effective for EUS-LA.

Keywords: Ablation; EUS; Lauromacrogol; Pancreatic cystic neoplasm.

Figure 1

EUS-LA procedure. A, PCN was scanned by EUS. B, Color Doppler flow imaging showed no obvious blood flow signal inside the PCN. C, PCN was scanned by CE-EUS to further evaluate the internal structure. D, The fluid inside the PCN was aspirated using EUS-FNA and was sent for examination. E, SpyGlass revealed a “branch-like” vascular network on the cyst wall. F, EUS-TTNB, biopsy specimen was sent for pathology examination. G, EUS-LA, microbubbles can be seen inside the PCN after the injection of lauromacrogol. H, The needle was retracted to observe whether there was active bleeding at the puncture site.

Figure 2

MIMICS automatically calculate and display the volume of the tumor after 3D reconstruction (the volume shows in the red box).

Figure 3

Study flowchart.

Figure 4

PCNs almost completely disappeared after EUS-LA with different doses lauromacrogol injection. A, Preoperative MRI showed a cystic lesion (SCN) with a maximum cross-sectional area of approximately 50 mm × 42 mm in the head of the pancreas. B, Follow-up MRI at 11 months after EUS-LA (with 1% lauromacrogol injection) showed that the lesion had almost completely disappeared (red circle). C, Preoperative MRI showed a cystic lesion (SCN) with a maximum cross-sectional area of approximately 36 mm × 25 mm in the head of the pancreas. D, Follow-up MRI at 12 months after EUS-LA (with 2% lauromacrogol injection) showed that the lesion had almost completely disappeared (red circle). E, Preoperative MRI showed a cystic lesion (MCN) with a maximum cross-sectional area of approximately 24 mm × 20 mm in the pancreatic body. F, Follow-up MRI 3 months after EUS-LA (with 3% lauromacrogol injection) showed that the lesion had disappeared completely (red circle).