Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor

Armellini, Elia; Crinò, Stefano Francesco; Ballarè, M.; Occhipinti, Pietro

doi:10.1055/s-0034-1393677

Cited by 50 publications

(42 citation statements)

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“…25 A favorable response was observed in PNET, either with complete ablation estimated at a 1-month image in one case or with a vascularity change with central necrosis in the other two PNET. 22,24,26 Two mucinous cysts had complete resolution, and the volumes of the other four cysts were nearly halved. 22 Biochemical improvement was observed within the first 48 h after RF in three insulinoma patients who remained free of symptoms at 1-year follow up.…”

Section: Methodsmentioning

confidence: 99%

“…Translation of animal experiments into clinical human use has been limited. In a recent review by Alvarez-S anchez et al, a total of 42 patients (from seven publications) underwent EUS-guided RFA with varied indications (unresectable PC in 28 patients, PNET in 7, mucinous cysts in 4, IPMN in 2 and microcystic adenoma in 1) [20][21][22][23][24][25][26][27] (Table 2). Some patients with a resectable tumor were either unfit for surgery or refused surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The internal cooling system, which helps prevent charring of the electrode surface enabling efficient transmission of heat, is available with the cryotherm probe and the EUSRA RF electrode. [20][21][22][23][24][25][26][27] The EUS-RFA probes can be broadly classified as a 'through-the-needle' device and as an 'EUS-FNA needle-type' device. The needle-type RFA device (i.e.…”

Section: Eus-guided Radiofrequency Ablationmentioning

confidence: 99%

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Endoscopic ultrasonography‐guided tumor ablation

Lakhtakia

Seo

2017

Digestive Endoscopy

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Real-time guidance of needle advancement has transformed endoscopic ultrasound (EUS) from a diagnostic to an interventional procedure. EUS-guided fine-needle puncture has application in various interventional procedures (drainage of pseudocyst, biliary intervention, and injection of drugs). Celiac plexus or ganglion neurolysis for pain control is the major current EUS-guided fine-needle injection procedure. Feasibility and safety to accurately position needle devices and/or inject under real-time EUS imaging with precise delivery of interventional agent have expanded the use of EUS to ablate tumors. These include radiofrequency ablation, or delivery of fiducial markers, potential antitumor agents, or radioactive seeds, in the cancer mass. Minimally invasive EUS-guided antitumor therapy is primarily used for pancreatic cancer because of better anatomic access (vs other imaging modality) and the dismal prognosis (despite improvements in surgery and chemoradiation). Also, the response to parenteral chemotherapy in pancreatic cancer is poor because of suboptimal drug delivery resulting from hypovascularity and abundant desmoplasia. Other targets for EUS-guided tumor ablation are pancreatic neuroendocrine tumor and pancreatic cyst lesion, which are less aggressive and curable by resection. However, patients non-eligible for surgery may benefit from local EUSguided ablation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Eus-guided Radiofrequency Ablationmentioning

confidence: 99%

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Endoscopic ultrasonography‐guided tumor ablation

Lakhtakia

Seo

2017

Digestive Endoscopy

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“…[14][15][16][17] The outcomes reported complete ablation in two patients, central necrosis in one patient, and reduction of tumor size in three patients. [14][15][16][17] A recent case series including only three insulinoma showed quick symptomatic and biochemical improvement within 2 days following the RFA, with sustained results at 2 years of follow-up. 15 In the present study, the final therapeutic efficacy reached a CR in 63.1% of the tumors after median follow-up of 28 months.…”

Section: Discussionmentioning

confidence: 99%

Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasound for the Guidance and Monitoring of Endoscopic Radiofrequency Ablation

et al. 2020

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Background/Aims: Interventional endoscopists may utilize contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) for image guidance during radiofrequency ablation (RFA) because of its capability to delineate real-time tumor perfusion dynamics. The purpose of this study was to assess the utility of CEH-EUS for the guidance and monitoring of endoscopic RFA. Methods: Nineteen consecutive patients with solid abdominal tumors who underwent CEH-EUS and endoscopic RFA were included. The extent of the ablation was assessed by CEH-EUS at 5 to 7 days after RFA. Additional RFAs were performed under CEH-EUS guidance. Results: The diagnoses were as follows: nonfunctioning neuroendocrine tumor (n=13), solid pseudopapillary neoplasm (SPN) (n=2), insulinoma (n=1), left adrenal adenoma (n=2), and left adrenal oligometastasis (n=1). Pre-CEH-EUS findings revealed that 17 cases showed hyperenhanced patterns and two cases of SPN showed isoenhanced patterns. CEH-EUS-assisted RFA was technically feasible in all 19 patients. After the first RFA session, seven patients of the treated tumors showed the disappearance of intratumoral enhancement on CEH-EUS, whereas 12 showed residual contrast enhancement. Twelve patients with incomplete ablation were further treated with additional RFA under real-time CEH-EUS guidance. Radiologic complete response was observed in 13 patients (68.4%). Among the 35 ablation procedures, the only adverse events were two episodes of pancreatitis (5.7%; 1 moderate and 1 mild). During the median follow-up of 28 months, the local recurrence rate was 7.7%. Conclusions: The application of CEH-EUS for RFA could be helpful in assessing early treatment response after ablation and targeting residual viable tumors during additional ablation sessions.

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“…Thermal exposure above 45 °C results in denaturation of cell proteins and is utilized in the treatment of various tumors[17]. …”

Section: Mechanism Of Rfamentioning

confidence: 99%

Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search

Chaudhary¹,

Sun²

2017

WJG

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Radiofrequency ablation (RFA) has been widely used for the treatment of various solid organ malignancies. Over the last decade, endosonographers have gradually shifted the application of RFA from porcine models to humans to treat a spectrum of diseases. RFA is performed in patients with pancreatic carcinoma who are not candidates for surgery. In this paper, we will discuss various indications for RFA, its procedural details and complications. At present, endoscopic ultrasound-guided RFA is gradually incorporated into the management of various diseases and opens a new avenue for disease treatment.

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Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor

Cited by 50 publications

References 0 publications

Endoscopic ultrasonography‐guided tumor ablation

Endoscopic ultrasonography‐guided tumor ablation

Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasound for the Guidance and Monitoring of Endoscopic Radiofrequency Ablation

Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search

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