Endoscopic Radiofrequency Ablation of the Pancreas

Abstract

Radiofrequency ablation (RFA) is a well-established technique to ablate dysplastic and neoplastic tissue via local thermal coagulative necrosis. Despite the widespread use in management of several cancers, the application of RFA in pancreas has been limited due to the increased risks of complications from the increased sensitivity of pancreatic tissue to thermal injury and proximity to vascular and biliary structures. RFA has been successfully used during laparotomy for locally advanced pancreatic carcinoma but requires an invasive approach. Endoscopic ultrasound-guided RFA offers the best combination of excellent visualization, real-time imaging guidance, and precise localization with minimal invasiveness. Several animal and human studies have demonstrated the technical feasibility and safety of endoscopic RFA in the pancreas. This article provides a comprehensive review of endoscopic RFA in the management of pancreatic lesions.

EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model

“…Preliminary feasibility studies of cytoreduction or debulking in locally advanced pancreatic adenocarcinoma have shown a significant effect in terms of tumor volume reduction, but did not improve survival 7 8 . Some recent data obtained in small series of patients suggest that morbidity associated with EUS RFA is acceptable, with a low rate of pancreatitis and pancreatic fistulae 5 6 9 . For benign or focal pancreatic lesions, such as pancreatic cystic lesions (intraductal papillary mucinous neoplasms or mucinous cystadenomas) or small, low-grade neuroendocrine tumors, RFA might become an alternative to surgical resection and possibly reduce the need for lifelong surveillance of patients 8 9 10 11 .…”

“…Pancreatic radiofrequency ablation (P-RFA) has been studied since 1999 and can be performed endoscopically using endoscopic ultrasound (EUS) guidance 4 . While clinical feasibility studies have already been conducted 5 , the scope of the technique, which could extend from neuroendocrine tumors and intraductal papillary mucinous neoplasms (IPMN) to large lesions, including unresectable pancreatic adenocarcinoma, is as yet unclear 6 . Furthermore, different devices are currently available for EUS-guided pancreatic RFA, two of which, described below, have recently been made commercially available for clinical use.…”

New Indications for Endoscopic Radiofrequency Ablation

“…EUS-guided RFA offers the best combination of real-time visualization and precise localization coupled with a minimally invasive strategy to achieve selective ablation of a variety of lesions previously inaccessible or difficult to access via percutaneous routes. 64 At present, EUS-guided RFA has been shown to be effective for targeting lesions within the liver, pancreas, lymph node, and for ablation of celiac ganglia for pain control in pancreatic carcinoma. Although these indications remain experimental and currently performed only at centers with expertise under predetermined protocols, there are emerging data supporting a potential role for EUS-guided RFA in select patients.…”

The Possibilities of Modern Methods of Ablation in Non-Resectable Locally Advanced Pancreatic Cancer

“…Разработка новых технологий и внедрение их в медицинскую практику позволили значительно снизить травматичность РЧА опухолей поджелудочной железы путем разработки технологии эндоскопического ее проведения под контролем ЭУС. Данная методика характеризуется минимальной инвазивностью процедуры, высокой точностью навигации, возможностью максимально селективной абляции опухолевого очага [13].…”