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

Abstract

Radiofrequency ablation (RFA) has been regarded as an established technique to treat various diseases such as hepatocellular carcinoma, renal cell carcinoma and Barret's esophagus. Although the application of RFA in the pancreas has been limited due to increased risk of adverse events, endoscopic ultrasound-guided RFA (EUS-RFA) has generated interest as a novel minimally invasive treatment modality which combines real-time visualization with a precise localization of the treatment procedure. For over a decade, the optimization of RFA devices have made EUS-RFA relatively safe, and several studies have supported its feasibility. However, there is insufficient evidence to suggest the appropriate indications and to describe long-term outcomes of EUS-RFA for various pancreatic neoplasms such as pancreatic neuroendocrine tumor, ductal adenocarcinoma, and cystic lesions. Therefore, this review focuses on the technical aspects and clinical applications of EUS-RFA for each pancreatic disease.

A Case Report on Longitudinal Collection of Tumour Biopsies for Gene Expression-Based Tumour Microenvironment Analysis from Pancreatic Cancer Patients Treated with Endoscopic Ultrasound Guided Radiofrequency Ablation

“…Following EUS examination of the pancreas and primary tumour site, an FNAB of the tumour was taken and then targeted RF delivered using 10 Watts for 2 min per application using the Habib EUS RFA (Boston Scientific, Marlborough, MA, USA) [ 29 ]. For the second and third EUS examinations, the ablation zone was examined, and a fine-needle biopsy was taken prior to RFA.…”

A review of the recent advances in endoscopic retrograde cholangiography-guided intraductal radiofrequency ablation for malignant biliary strictures

“…2 During RFA, a high-frequency alternating current is applied directly to the target lesion, resulting in coagulative necrosis. A perturbation of positive and negatively charged ions within the tissue produces friction heat 5 that is proportional to the voltage of the high-frequency current and the irradiation time, and is inversely proportional to the distance from the electrode. At temperatures ≥ 50°C, cells undergo coagulation necrosis, which is reversible and damages cytosolic and mitochondrial enzymes.…”

“…The most commonly used local thermal ablation technique is RFA, 3 which can be performed using different approaches including intraoperative and percutaneous approaches under ultrasound or radiological imaging guidance, an endoscopic approach using endoscopic ultrasound, or endoscopic retrograde cholangiopancreatography (ERCP). 4 The present review describes ERCP-guided intraductal RFA (ID-RFA), which has been widely used for many years and has been in the spotlight recently for the treatment of malignant biliary strictures.…”