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Endoscopy 2019; 51(09): 836-842
DOI: 10.1055/a-0824-7067
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study

Marc Barthet
1   Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France
,
Marc Giovannini
2   Endoscopy Unit, Institut Paoli Calmettes, Marseille, France
,
Nathalie Lesavre
3   Centre d’Investigation Clinique, Hôpital Nord, Marseille, France
,
Christian Boustiere
4   Service d’Hépato-gastroentérologie, Hôpital Saint-Joseph, Marseille, France
,
Bertrand Napoleon
5   Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
,
Stéphane Koch
6   Department of Gastroenterology, CHRU Minjoz, Besançon, France
,
Mohamed Gasmi
1   Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France
,
Geoffroy Vanbiervliet
7   Centre Hospitalier Universitaire de Nice, Hôpital L’Archet 2, Nice, France
,
Jean-Michel Gonzalez
1   Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France
› Author AffiliationsTRIAL REGISTRATION: prospective multicenter study NCT02330497 at clinicaltrials.gov
Further Information

Publication History

submitted 21 June 2018

accepted after revision 12 November 2018

Publication Date:
22 January 2019 (online)

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Abstract

Background Pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features are surgically managed. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been developed. The safety of EUS-RFA was the primary end point of this study, its efficacy the secondary end point.

Methods This was a prospective multicenter study that was planned to include 30 patients with a 1-year follow-up with either a NET < 2 cm or a pancreatic cystic neoplasm (PCN), either a branch duct IPMN with worrisome features or a mucinous cystadenoma (MCA). EUS-RFA was performed with an 18G RFA cooling needle.

Results 12 patients had 14 NETs (mean size 13.1 mm, range 10 – 20 mm); 17 patients had cystic tumors (16 IPMNs, 1 MCA; mean size 28 mm, range 9 – 60 mm). Overall three adverse events occurred (10 %), two of these in the first two patients (one pancreatitis, one small-bowel perforation). After these initial patients, modifications in the protocol resulted in a decrease in complications (3.5 %), with one patient having a pancreatic ductal stenosis. Among the 14 NETs, at 1-year follow-up 12 had completely disappeared (86 % tumor resolution), with three patients having a delayed response. Among the 17 PCNs, at 12 months, there were 11 complete disappearances and one diameter that decreased by > 50 % (significant response rate 71 %). All 12 mural nodules showed complete resolution.

Conclusions EUS-RFA of pancreatic NETs or PCNs is safe with a 10 % complication rate, which can be decreased by improved prophylaxis for the procedure.

 

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