Efficacy and safety of endoscopic ultrasound-guided radiofrequency ablation for management of pancreatic lesions: a systematic review and meta-analysis

Abstract

Background: Radiofrequency ablation (RFA) has been used to treat various abdominal tumors including pancreatic tumors. Multiple approaches such as laparoscopic, open, and percutaneous have been used for pancreatic tissue ablation. More recently, endoscopic ultrasound (EUS)-guided RFA has emerged as a new technique for pancreatic tissue ablation. The role of EUS-RFA in management of pancreatic lesions is still not well-established. In this study, our aim is to assess efficacy and safety of EUS-RFA for management of pancreatic lesions.Methods: MEDLINE, Scopus, and Cochrane Library databases were searched to identify studies reporting EUS-RFA of pancreatic lesions with outcomes of interest. Studies with <5 patients were excluded. Clinical success was defined as symptom resolution, decrease in tumor size, and/or evidence of necrosis on radiologic imaging. Efficacy was assessed by the pooled clinical response rate whereas safety was assessed by the pooled adverse events rate. Heterogeneity was assessed using I 2 . Pooled estimates and the 95% CI were calculated using random-effect model.Results: Ten studies (5 retrospective and 5 prospective) involving 115 patients with 125 pancreatic lesions were included. 152 EUS-RFA procedures were performed. The lesions comprised of 37.6% non-functional neuroendocrine tumors (NFNETs), 15.4% were insulinomas, 26.5% were pancreatic cystic neoplasms (PCNs), and 19.7% were pancreatic adenocarcinomas. The majority were present in the pancreatic head (40.2%), 38.3% in the body, 11.2% in the tail, and 10.3% in the uncinate process. Pooled overall clinical response rate was 88.9% (95% CI: 82.4-93.7, I 2 =38.1%). Pooled overall adverse events rate was 6.7% (95% CI: 3.4-11.7, I 2 =34.0%). The most common complication was acute pancreatitis (3.3%) followed by pancreatic duct stenosis, peripancreatic fluid collection, and ascites (2.8%) each. Only one case of perforation was reported with pooled rate of (2.1%).Conclusions: This study demonstrates that EUS-RFA is an effective treatment modality for pancreatic lesions, especially functional neuroendocrine tumors such as insulinomas.

Surgical Management of Pancreatic Neuroendocrine Tumors

“…This modality induces coagulative necrosis via directed thermal energy, and it has been used in the treatment of other solid tumors. Several studies have demonstrated this technique is safe and with minimal post-procedure complications [ 64 , 65 ]. From a technical standpoint, clinical success appears to be higher for insulinomas that are located in head or neck of the pancreas [ 65 ].…”

“…From a technical standpoint, clinical success appears to be higher for insulinomas that are located in head or neck of the pancreas [ 65 ]. While studies are limited, endoscopic ultrasound-guided radiofrequency has demonstrated symptomatic improvement after radiofrequency [ 64 ]. Additional studies are needed, but minimally invasive techniques for the treatment of insulinomas are feasible and may provide benefit by way of sparing healthy pancreatic tissue.…”

Utility of interventional endoscopic ultrasound in pancreatic cancer

“…Overall, EUS-RFA appears to be fairly safe with a recent meta-analysis of 115 patients (with various pancreatic lesions being treated) demonstrating a pooled adverse event rate of 6.7% (95% CI: 3.4–11.7, I2 = 34.0%), the commonest being acute pancreatitis (3.3%) ( 139 ).…”

Insulinoma - review of characteristics, diagnosis and treatment

“…Skuteczność oceniono na 88,9%, zaś odsetek zdarzeń niepożądanych 6,7%. [15] W przypadkach guzów złośliwych można rozważyć usunięcie zmiany razem z regionalnym układem chłonnym. Przerzuty do wątroby mogą być również usunięte lub leczone za pomocą embolizacji błony śluzowej, radioembolizacji (SIRT), ablacji prądem o częstotliwości radiowej (RFA), ablacji mikrofalowej i krioablacji, zogniskowanych ultradźwięków o dużej intensywności (HIFU), lasera, brachyterapii i nieodwracalnej elektroporacji (IRE) w zależności od lokalnej dostępności.…”