Treating Pancreatic Cysts With EUS-Guided Chemoablation

UVA Health is the first in Virginia to offer endoscopic ultrasound (EUS)-guided chemoablation for pancreatic cysts. In our experience, 65-70% of cysts treated with this approach either disappear or shrink.

“Pancreatic cysts are not always precancerous, but some carry a higher risk of progressing to pancreatic cancer,” says Ross Buerlein, MD, a gastroenterologist who performs interventional endoscopic procedures at UVA Health. “Chemoablation allows our team to manage these cysts to prevent malignancy without resorting to major surgery.”

Advantages for Appropriate Patients

Traditional management of pancreatic cysts often involves surveillance with periodic imaging to monitor for features that suggest cancer risk. When cysts appear high-risk, surgical removal is the standard of care — but surgery can be extensive and is not always possible for older or medically complex patients.

Chemoablation is an alternative that provides:

• Effective treatment of the cyst in most cases
• Shorter recovery and hospital stays
• Greater safety and comfort

This therapy is for patients with mucinous pancreatic cysts that are not malignant. People with benign cysts, such as serous cystadenomas, are treated differently. Eligibility also depends on the individual’s overall health and the cyst’s growth rate, size, and shape.

“The therapy offers a nonsurgical option for patients who might otherwise require major pancreatic surgery or who are not candidates for surgery due to age or comorbidities,” says Vanessa Shami, MD, a gastroenterologist and interventional endoscopist at UVA Health. “Pancreatitis is a possible complication, although that can sometimes indicate a successful ablation.”

How Chemoablation Works 

Unlike traditional ablation, which uses heat or freezing, chemoablation delivers chemotherapy agents directly into the cyst using a fine needle — without the side effects associated with chemotherapy given intravenously. Guided by EUS imaging, UVA Health clinicians achieve accurate needle placement and precise delivery of therapy while minimizing systemic exposure.

The localized treatment provides targeted therapy with less discomfort and a faster recovery compared with surgical resection.

A Minimally Invasive, Outpatient Procedure

EUS-guided chemoablation is an outpatient procedure that involves three main steps.

• Locate the cyst — A thin, flexible tube with an ultrasound probe is inserted through the mouth into the digestive tract, giving a detailed view of the pancreas and accurate identification of cysts.
• Drain the cyst — A fine needle aspirates fluid from the cyst cavity.
• Inject the chemotherapy — The chemotherapy solution is injected directly into the cyst, limiting systemic exposure and minimizing side effects.

Prior to undergoing EUS-guided chemoablation, most patients will first undergo an EUS to sample the cyst fluid to assess for the presence of underlying cancerous cells and to confirm that the cyst is mucinous. Based on these results, the patient may undergo a separate EUS procedure for the actual chemoablation at a later time.

Most patients require long-term monitoring after the procedure, says Shami, to confirm complete resolution and detect any early changes. “The procedure shows promising results in terms of efficacy and long-term durability,” she adds.