Efficacy of EUS-RFA in pancreatic tumors: Is it ready for prime time? A systematic review and meta-analysis

Abstract

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) can be used in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). We performed a systematic review and meta-analysis to evaluate the efficacy of EUS-RFA in treatment of locally advanced unresectable PDAC and other pancreatic tumors. Patients and methods A comprehensive search was done of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of EUS-RFA for pancreatic lesions. The primary outcome was to evaluate technical and clinical success of the procedure. The secondary outcome was to study overall adverse events (AEs). Results Thirteen studies reporting 165 EUS-RFA procedures on 134 patients were included. Of 134 patients, 27.94 % (38) had unresectable locally advanced PDAC, 40 % (53) had PNETs, 3 % (4) had metastasis to the pancreas and 30 % (41) had other lesions. The pooled technical success rate calculated out of the total number of procedures was 100 % (95 % CI [99.18 – 100], I2 = 0 %). The pooled clinical success rate calculated out of the total number of patients was 91.58 % (95 % CI [82.5 – 98.08], I2 = 21.5 %). The pooled overall AE rates were 14.67 % (95 % CI [4.77 – 27.46], I2 = 56.19 %) out of which abdominal pain was the most common with 9.82 % (95 % CI [3.34 – 18.24], I2 = 23.76 %). Low to moderate heterogeneity was noted. Conclusion EUS-RFA has high technical (100 %) and clinical success (91.5 %) rates. Further multicenter trials are needed to further validate our findings.

Endoscopic Ultrasound-guided Radio-frequency Ablation for Pancreatic Cancer

“…In this systematic review, which recruited several kinds of pancreatic tumor including pancreatic adenocarcinoma (n=38) pancreatic neuroendocrine neoplasm (n=53), metastasis to the pancreas (n=4) and other pancreatic lesions (n=41), reported adverse events rate associated with EUS-RFA at 14.7 %, of which, the abdominal pain was the most common event at 9.8%. 9 Based on our institutional experience and results from prior studies, neither death nor serious adverse events occurred from the result of the EUS-RFA procedure. In our experience, the only one adverse event that we had was mild pancreatitis which was successfully treated with conservative treatment.…”

“…8 A recent systematic review of 38 patients with unresectable pancreatic cancer reported technical and clinical success rate at 100% (38/38) and (26/26). 9 The technical success was defined as a successful placement of the EUS-RFA probe into the target lesions, and the clinical success was defined as necrosis of target lesion by EUS-RFA. In this systematic review, which recruited several kinds of pancreatic tumor including pancreatic adenocarcinoma (n=38) pancreatic neuroendocrine neoplasm (n=53), metastasis to the pancreas (n=4) and other pancreatic lesions (n=41), reported adverse events rate associated with EUS-RFA at 14.7 %, of which, the abdominal pain was the most common event at 9.8%.…”

Current role of endoscopic ultrasound in the diagnosis and management of pancreatic cancer

“…Another meta-analysis evaluated this technique for the treatment of different types of pancreatic tumors and showed a technical success of 100%, a clinical success of 91.5% and an overall adverse event rate of 14.6%, where abdominal pain was the most frequently reported[ 62 ]. Most available studies that have evaluated this technique are small-sized studies with fewer than 10 patients and uncontrolled protocols.…”

Personalized Approach to the Role of Endoscopic Ultrasound in the Diagnosis and Management of Pancreaticobiliary Malignancies

“…A recently published systematic review and meta-analysis of 13 studies including 134 patients reported the technical success rate to be 100% and clinical success to be 92%. The pooled overall adverse event rates were 15%, with abdominal pain being the most reported at 9.8% [ 75 ].…”