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
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.
References
1
Farrell JJ.
Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver 2015; 9: 571-589
2
Tanaka M,
Fernández-Del Castillo C,
Kamisawa T.
et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753
5
Strosberg JR,
Cheema A,
Weber J.
et al. Prognostic validity of a novel American Joint Committee on Cancer Staging Classification for pancreatic neuroendocrine tumors. J Clin Oncol 2011; 29: 3044-3049
8
Lakhtakia S.
Therapy of pancreatic neuroendocrine tumors: fine needle intervention including ethanol and radiofrequency ablation. Clin Endosc 2017; 50: 546-551
10
Brugge WR,
Lewandrowski K,
Lee-Lewandrowski E.
et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126: 1330-1336
11
Okabayashi T,
Kobayashi M,
Nishimori I.
et al. Clinicopathological features and medical management of intraductal papillary mucinous neoplasms. J Gastroenterol Hepatol 2006; 21: 462-467
13
Oh H-C,
Seo DW,
Lee TY.
et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008; 67: 636-642
15
Zacharoulis D,
Lazoura O,
Rountas C.
et al. Experimental animal study of a novel radiofrequency endovascular occlusion device. Am J Surg 2011; 202: 103-109
16
Sethi A,
Ellrichmann M,
Dhar S.
et al. Endoscopic ultrasound-guided lymph node ablation with a novel radiofrequency ablation probe: feasibility study in an acute porcine model. Endoscopy 2014; 46: 411-415
22
Song TJ,
Seo DW,
Lakhtakia S.
et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc 2016; 83: 440-443
23
Arcidiacono PG,
Carrara S,
Reni M.
et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc 2012; 76: 1142-1151
24
Crinò SF,
D’Onofrio M,
Bernardoni L.
et al. EUS-guided radiofrequency ablation (EUS-RFA) of solid pancreatic neoplasm using an 18-gauge needle electrode: feasibility, safety, and technical success. J Gastrointest Liver Dis 2018; 27: 67-72
25
Lakhtakia S,
Ramchandani M,
Galasso D.
et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 2016; 83: 234-239
26
Rossi S,
Viera FT,
Ghittoni G.
et al. Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas 2014; 43: 938-945
27
Armellini E,
Crinò SF,
Ballarè M.
et al. Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor. Endoscopy 2015; 47 (Suppl. 01) E600-E601
28
Pai M,
Habib N,
Senturk H.
et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg 2015; 7: 52-59
