Endoscopic ultrasound guided radiofrequency ablation for pancreatic tumors: A critical review focusing on safety, efficacy and controversies

Abstract

The role of endoscopic ultrasound (EUS) in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreato-biliary disorders. In recent years, its applications for treating pancreatic diseases have broadened, including the implementation of radiofrequency ablation (RFA), which has been traditionally used for treating solid tumors. In this critical in-depth review, we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms, adenocarcinoma, and pancreatic cystic lesions. Overall, for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA, with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%. For pancreatic adenocarcinoma, we identified 8 papers with 121 patients. Adverse events occurred in 13% of patients, mostly rated mild. However, no clear survival benefit was demonstrated. For pancreatic cystic lesions, we identified 4 papers with 38 patients. The adverse events were mostly mild and occurred in 9.1% of patients, and complete or partial radiological resolution of the cysts was reported in 36.8%. Notably, the procedure was technically feasible for most of the patients. Nevertheless, a long road remains before this technique finds its definite place in guidelines due to several controversies. EUS-RFA for pancreatic tumors seems to be safe and effective, especially for pancreatic neuroendocrine neoplasms, but multicenter prospective trials are needed to consider this treatment as a gold standard.

Safety and efficacy of endoscopic ultrasound‐guided radiofrequency ablation for pancreatic neuroendocrine neoplasms: Systematic review and meta‐analysis

“…Our data were compatible with a recent review article that showed a technical success of 100%, and complete radiological success of 90%. 28 Moreover, the clinical success rate in our study, especially in patients with F-pNENs, was high, 94.9% (95% CI 90.7-97.9%). To date, only few systematic reviews and meta-analyses assessing EUS-RFA for pNENs with a relatively low number of patients were published.…”

“…Similarly, the complete radiological response was high in 87.1% (95% CI 80.1–92.8%). Our data were compatible with a recent review article that showed a technical success of 100%, and complete radiological success of 90% 28 . Moreover, the clinical success rate in our study, especially in patients with F‐pNENs, was high, 94.9% (95% CI 90.7–97.9%).…”

Unraveling the enigma: A comprehensive review of solid pseudopapillary tumor of the pancreas

“…The benefit of observation is the avoidance of the morbidity and mortality associated with pancreatic resection[ 91 ]. With advancements in interdisciplinary approaches, EUS-guided RFA (EUS-RFA) has emerged as a potential treatment option for pancreatic tumors[ 92 ]. In a study by Choi et al [ 93 ], two patients with SPTP underwent EUS-RFA without experiencing any procedure-related adverse events, and one patient achieved a complete response.…”

How to implement adverse events as a quality indicator in gastrointestinal endoscopy

“…[36][37][38] Acute pancreatitis is a known AE after ERCP but also after endoscopic ultrasound-guided radiofrequency ablation of pancreatic lesions and even after antegrade device-assisted enteroscopy. [37][38][39][40][41] Splenic injury is a rare AE related to a difficult colonoscopy. 42 Postpolypectomy coagulation syndrome with localized peritonitis is related to endoscopic resection techniques in the colon using coagulation, and even coagulation-induced gas explosion with colonic perforation has been described after incomplete bowel preparation.…”

“…Retained food during upper gastrointestinal endoscopy is a risk factor for aspiration pneumonia 36–38 . Acute pancreatitis is a known AE after ERCP but also after endoscopic ultrasound‐guided radiofrequency ablation of pancreatic lesions and even after antegrade device‐assisted enteroscopy 37–41 . Splenic injury is a rare AE related to a difficult colonoscopy 42 .…”