Society: ASGE

Background and Aims
Surgical resection is a standard treatment option for management of pancreatic cysts. The newly introduced EUS-guided ethanol ablation (EUS-ablation) has been performed as an alternative to pancreatectomy in selected patients and is expected to reduce the high rates of short-and long-term morbidity of pancreatectomy. However, no comparative studies have been carried out between EUS-ablation and pancreatectomy for pancreatic cysts.
Methods
We reviewed the prospectively collected pancreatic cyst database to analyze consecutive patients with unilocular or oligolocular pancreatic cysts requiring treatment who underwent EUS-ablation or pancreatectomy between January 2015 and July 2021. After excluding cases in which malignancies were suspected preoperatively, we performed 1:1 match using propensity score matching based on age, gender, cyst size, cyst morphology (unilocular or oligolocular), cyst location, and American Society of Anesthesiologists (ASA) physical status classification between EUS-ablation and pancreatectomy. Complete remission rates, adverse events, mortality, and occurrence of diabetes were evaluated.
Results
A total of 620 patients (310 EUS-ablation, 310 pancreatectomy) were selected after propensity score matching. During follow-up, rate of complete resolution of pancreatic cysts was lower in EUS-ablation group (77% vs. 100%; P = 0.001). However, the EUS-ablation group showed lower rates of early adverse events (EUS-ablation, 12.6% vs. pancreatectomy, 46.5%; P = 0.001), late adverse events (1% vs. 16%; P = 0.001), occurrence of diabetes (0% vs. 18%; P = 0.001), unplanned readmissions (1% vs. 15%; P = 0.001), and cumulative morbidities at 5 years (11.3% vs. 37.5%; P = 0.001) than did the pancreatectomy group. There were significant differences in the severity of the adverse events: mild (10% vs. 16%; P = 0.018); moderate (2% vs. 15%; P = 0.001); severe (0% vs. 3%; P = 0.004). The EUS-ablation group required interventions for adverse events less frequently than the pancreatectomy group did (1% vs. 10%; P = 0.001). Procedure or surgery-related mortality rates in EUS-ablation group and pancreatectomy group was 0% and 0.3%, respectively.
Conclusions
In management of unilocular or oligolocular pancreatic cyst, EUS-guided ethanol ablation might be a good alternative to pancreatectomy in selected patients regarding morbidity and mortality benefits.

Dong Wan Seo

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