EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

Abstract

Background & Aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for the treatment of pancreatic neoplasm. We evaluated the feasibility, safety, and technical success of pancreatic EUS-RFA performed in a single center.Methods: 9 consecutive patients (8 with pancreatic adenocarcinoma and 1 with renal cancer metastasis) were referred for EUS-RFA between November 2016 and July 2017. EUS-RFA was performed using 18-gauge internally cooled electrode with a 5 or 10 mm exposed tip. Feasibility, technical success or early and late adverse events were assessed.Results: One patient was excluded because of a large necrotic portion. EUS-RFA was feasible in all the other 8 (100%) cases. An ablated area inside the tumor was achieved in all treated patients. No early or late major adverse event was observed after a mean follow-up of 6 months. Three patients experienced mild postprocedural abdominal pain.Conclusions: EUS-RFA seems a feasible, safe, and effective procedure for pancreatic neoplasms. Its role in the treatment and management of pancreatic masses must be further investigated.

Recent developments in endoscopic ultrasound-guided radiofrequency ablation for pancreatic lesions

“…Previous experiments of 1 to 8 patients have been published showing the feasibility of EUS-RFA in this setting (Table 1). 11,[14][15][16][17][18][19][20][21][22][23] One recent prospective study 11 including 14 PNENs (G1, <2 cm) demonstrated a 6-months success rate of 71%, whereas 85.7% of tumors completely disappeared at 12 months, possibly due to the late response related to RFA related immunomodulation. Two RFA related adverse events of acute necrotic pancreatitis and pancreatic duct stricture developed.…”

“…Available experiments of EUS-RFA of PDAC include a few small cohorts and focus mainly on technical feasibility and safety (Table 1). 11,[14][15][16][17][18][19][20][21][22][23] From these researches, EUS-RFA is technically feasible and has no major procedure-related adverse events such as mortality. Most RFA related adverse events were minor, such as self-limiting postprocedural abdominal pain.…”

“…Most RFA related adverse events were minor, such as self-limiting postprocedural abdominal pain. As for efficacy, when a 30-day CT was executed, 18,19 an ablative necrotic area was identified compared to the original tumor volume (between 5.7% and 73.5%). 18 However, there are several problems in the interpretation of these results.…”

“…As for efficacy, when a 30-day CT was executed, 18,19 an ablative necrotic area was identified compared to the original tumor volume (between 5.7% and 73.5%). 18 However, there are several problems in the interpretation of these results. There is a lack of data on long-term survival, and the differences between the three RFA catheters were not evaluated.…”

“…Unlike PDAC and PNEN, previous experiments on PCL are relatively few (Table 1). 11,[14][15][16][17][18][19][20][21][22][23] A prospective study including 17 PCLs (mean size, 28 mm; range, 9-60 mm) of 16 intraductal papillary mucinous neoplasms with worrisome features and one mucinous cystic adenoma unfit for surgery demonstrated a 71% significant response rate at 12 months. (11 complete disappearances and one partial response in which the diameter was decreased by > 50%).…”