P156 A prospective multicenter study of the endoscopic ultrasound-guided radiofrequency (EUS-RFA) vs ethanol ablation (EUS-EA) for pancreatic neuroendocrine tumors and Adenocarcinoma

Abstract

<h3>Introduction</h3> RFA and EUS-EA are emerging novel methods for managing non-functioning and functioning pNET and adenocarcinoma in the pancreas. We aim to assess the safety profile, feasibility, and outcomes of EUS-RFA and EUS-EA of focal pancreatic masses. <h3>Methods</h3> This prospective study included 27 patients, 15 males and 12 females, with a mean age of 36.38 years. EUS-RFA was carried out in 13 patients; 11 had pancreatic insulinoma, and 2 had advanced pancreatic adenocarcinoma. The mean size of the masses was 20.6 mm, while that of the insulinomas was 17.4 mm. The median of the needle passes was 3, with a range of 1 to 6 passes. RFA was conducted using 19G EUSRA needles from Taewoong Co., Ltd., South Korea. No minor or major complications were observed. EUS-EA was carried out in 14 patients, all of whom had pancreatic insulinoma. The mean size of the masses was 15.3 mm. The median of the needle passes was 2, with a range of 1 to 3 passes. We used 19G and 22G echo tip FNA needles from Cook Company, USA. The mean duration of follow-up was 12.4 months. There was mild to moderate chronic pancreatitis in 4 patients in the EUS-EA group; all were relieved by conservative therapy, and no hospital admission was required. No early or late significant complications were reported in the EUS-RFA group. <h3>Results</h3> There was a complete clinical cure of 10 out of 11 (91%) patients with pancreatic insulinoma who underwent EUS-RFA. 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. 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 8 out of 14 (57%) patients with pancreatic insulinoma who underwent EUS-EA. No clinical cure was observed in 4 patients; 3 underwent major surgery, and the 4th one underwent EUS-RFA. The last two patients showed partial clinical response with decreased frequency, duration, and severity of hypoglycemic attacks. They were managed by diet regulation; no major surgery was needed. <h3>Conclusions</h3> 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. <h3>Reference</h3> Hassan Z, Gadour E. Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: a systematic review. <i>World J Gastroenterol</i>. 2022 Jul 21;<b>28</b>(27):3514–3523. doi: 10.3748/w jg.v28.i27.3514. PMID: 36158274; PMCID: PMC9346459.