EUS-GUIDED RADIOFREQUENCY ABLATION (RFA) FOR PANCREATIC PREMALIGNANT TUMOR: A NEW HOPE?

Aims:

Pancreatic NET and IPMN with worrisome features required surgical resection due to the respective risk of lymph nodes/metastatic widespread or invasive adenocarcinoma. The aim of this prospective study was: primary endpoint, to evaluate the safety of EUS-RFA in such pancreatic tumors; secondary endpoint: to assess the efficacy in a one year follow-up.

Methods:

This study was conducted as a prospective multicenter study planned to include 30 patients Patients with NET pancreatic tumor less than 2 cm or with pre-malignant pancreatic cystic tumor (side branches IPMN with worrisome features or mucinous cystadenoma (MCA)) were included. EUS-RFA was performed with a 18G RFA needle (Starmed, Taewong, Korea).

Results:

13 patients had 14 NET with a 13.4 mm size (8 – 20 mm) 18 patients had cystic tumor (17 IPMN, 1 MCA) with a 29.1 mm mean size (9 – 60 mm).

3 complications (10%) occured, two with the first patients included: one mild pancreatitis, one small bowel perforation surgically managed, one pancreatic ductal stenosis endoscopically managed. After these initial patients, the protocol was improved with prophylactic adminstration of NSAID and antibiotics and emptying the cyst fluid content leading to dramatic decrease of further complication (3.5%).

12 with NET had at 6 months: 7 a complete necrosis or disappearence, 2 a diameter decrease > 50%, (significant response 82%), 2 a diameter decrease < 50%, 1 a complete failure.

13 patients among 17 with IPMN were followed at least 6 months. Significant response occurred in 9 cases (69%) (7 complete resolution, 2 diameter decrease > 50%), 3 had complete failure and one partial response < 50%. Mural nodes disappeared in 10 cases among 12.

Conclusions:

EUS-RFA management of pancreatic NET or pancreatic cystic tumors is sefficient and safe with a 10% complication rate decreased with an improved prophylactic protocol study.