Endoscopic ultrasound-guided Fine Needle Aspiration (EUG-FNA) is a method by which tissue biospies are collected using a needle tip guided by real-time ultrasound imaging. UCI physicians propose a novel utility for EUS-FNA with enclosed fine needles that would allow the sterile injection of dyes, drugs and therapeutics to specific anatomical sites.
The needle device contains an outer needle that is plugged at the tip with a heat-sensitive waxy material. The waxy plug melts with body heat and allows penetration by the inner fine needle. This outer needle apparatus can traverse the gastrointestinal tract into the injection site. The sterile fine-needle can then be advanced through the guide wire to outer needle, penetrate the plug and be exposed to the site of injection. The injectable solution can be passed through a tube through the fine needle to the anatomical site, allowing sterile delivery.
EUS-FNA guided injection of 1) immunotherapeutics, 2) contrasts into the bile duct, pancreatic ducts and various blood vessels, 3) chemotherapeutic agents and 4) other biological modifiers at lymph nodes and tumors within and adjacent to the gastrointestinal tract.
·Enhances drug delivery to specific sites, such as within tumors, which can be difficult to penetrate
·On-site injections can enhance efficacy of low half-life drugs
·For toxic compounds, such as radioactive dyes and chemotherapeutics, site delivery can reduce off target effects and reduce effective doses.
·Coupling injection to real-time imaging allows for accurate injection at site
·The sterilized fine needle is passed through an outer needle and allows sterile injection at sites and is minimally invasive
The EUS-guided fine-needle injection (FNI) method was used in randomized phase III trial, in which the biologic TNFerade with fluorouracil and radiotherapy was administered locally using EUS-FNI locally to patients with advanced pancreatic cancer.
Phase I clinical trial of allogenic mixed lymphocyte culture (cytoimplant) was delivered using EUS-FNI in patients with advanced pancreatic carcinoma and was considered a feasible technique for use.