A prospective multicentre study of the endoscopic ultrasound-guided radiofrequency (EUS-RFA) and ethanol ablation (EUS-EA) in pancreatic neuroendocrine tumours and adenocarcinoma of the pancreas

Abstract

EUS-RFA and EUS-EA are emerging novel methods for managing non-functioning and functioning pNET and adenocarcinoma in the pancreas [1]. We aim to assess the safety profile, feasibility, and outcomes of EUS-RFA and EUS-EA of focal pancreatic masses. This prospective study included 27 patients, 15 males and 12 females, with a mean age of 36.38 years. All patients were presented with confirmed neoplastic pancreatic focal lesions and were subjected to local ablative therapy from January 2021 to June 2023. Statistical analysis was conducted by using Statistical Package for the Social Sciences (SPSS),29.0.10. There was a complete clinical cure of 10 out of 11 (91%) patients with pancreatic insulinoma who underwent EUS-RFA (Fig. 1). However, one patient required three sessions, and two patients required two sessions of EUS-RFA. The 11th patient with insulinoma showed poor response after the first session, then partial response after the second session of EUS-RFA (Fig. 2). The size of the two masses with advanced adenocarcinoma was decreased, but no downstaging of the masses was achieved. There was a complete clinical cure of eight out of 14 (57%) patients with pancreatic insulinoma who underwent EUS-EA. No clinical cure was observed in four patients; three underwent major surgery, and the fourth one underwent EUS-RFA. The last two patients showed partial clinical response with decreased frequency, duration, and severity of hypoglycaemic attacks. They were managed by diet regulation; no major surgery was needed. EUS-RFA and EUS-EA can potentially treat lesions and control symptoms. EUS-RFA is a more promising and safer technique for managing functioning insulinomas. However, it can not downstage PDAC patients. EUS-EA seems less efficient, with more adverse events than EUS-RFA.