EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers

Marx, Mariola; Trosic-Ivanisevic, Toni; Caillol, Fabrice; Demartines, Nicolas; Schoepfer, Alain; Pesenti, Christian; Ratone, JP; Robert, Maxime; Giovannini, Marc; Godat, Sébastien

doi:10.1016/j.gie.2021.11.045

Cited by 41 publications

(41 citation statements)

References 23 publications

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“…To date, a quite good number of observational studies with a very limited volume of patients have described the application of EUS-RFA in pancreatic insulinomas [15][16][17][18][19][20][21][22][23][24][25][26][27][28] . These are summarized in Table 3.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

Andreis

Boškoski

Mascagni

et al. 2022

Preprint

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Purpose Insulinomas are rare, functioning pancreatic neuroendocrine neoplasms (pNEN), whose gold standard therapy is surgical resection. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a recent technique that has emerged as minimally invasive therapeutic option for patients with pancreatic lesions not eligible for surgery. In this study, we aimed to describe a series of patients with unresectable pancreatic insulinoma treated with EUS-RFA. Methods This is a single-center, retrospective study including all consecutive patients with functioning pancreatic insulinoma undergoing EUS-RFA for surgical unfitness or surgery refusal, between March 2017 and September 2021. Technical success, radiologic response, and adverse events rate were evaluated. Results A total of 10 patients (mean age: 67.1 ± 10.1 years; F:M 7:3) were enrolled. The mean size of insulinoma was 11.9 ± 3.3 mm. Technical success was achieved in 100% of patients, with an immediate normalization of serum glucose levels. Only one (10%) patient was successfully treated with two RFA sessions. The complete radiologic response within 3 months after EUS-RFA was observed in all patients (100%). Persistent euglycemia was assessed at 6 and 12 months for each treated patient. Three procedure-related early adverse events occurred, including two (20%) cases of mild abdominal pain, and one (10%) case of intraprocedural bleeding with spontaneous hemostasis. No major complications were observed within 48 hours after the procedure. Conclusions Data of this case series suggest that EUS-RFA is a feasible and safe therapeutic approach for unresectable pancreatic insulinomas with long-term efficacy.

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Section: Discussionmentioning

confidence: 99%

“…Mild to severe procedure-related adverse events were described in 10 patients, including fever, edematous and necrotic acute pancreatitis, and bleeding 18,20,23,25,27,28 .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

Andreis

Boškoski

Mascagni

et al. 2022

Preprint

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“…Notably, this study was associated with a safety signal, as 3 patients had mild to moderate AEs and 1 patient (aged 97 years) had a severe AE with retrogastric collection. He refused drainage, was symptomatically treated and died 2 wk later[ 15 ]. The second study retrospectively reported 27 patients with G1 non-functional pNENs.…”

Section: Eus-rfa In Pnensmentioning

confidence: 99%

“…The procedure was technically feasible in all patients, and the AE rate was almost 21.9%, occurring in 25 of the 114 EUS-RFA sessions. Notably, most of the AE were mild and moderate according to the American Society of Gastrointestinal Endoscopy guideline[ 9 ] except for one fatal AE in a recent paper published by Marx et al [ 15 ]. Interestingly, the complete radiological resolution rate was approximately 90% during a follow-up period of 13 mo (Table 1 ).…”

Section: Eus-rfa In Pnensmentioning

confidence: 99%

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

Khoury¹,

Sbeit²,

Napoléon³

2023

World J Gastroenterol

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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.

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“…Radiofrequency ablation (RFA) has been used for the treatment of nonfunctional pancreatic neuroendocrine tumors (PNETs) < 2 cm 1 , functional PNETs (insulinoma) 2 , pancreatic metastasis of kidney cancer 3 , and isolated cases of intraductal papillary mucinous neoplasm (IPMN) with worrisome features 4 . We describe the use of RFA to treat a compressive cervical lymph node causing dysphagia ( Video 1 ).…”

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confidence: 99%

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

et al. 2022

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EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers

Cited by 41 publications

References 23 publications

Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

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

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

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