Long-term outcome after EUS-guided radiofrequency ablation: Prospective results in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms

Marc Barthet, Marc Giovannini, Mohamed Gasmi, Nathalie Lesavre, Christian Boustière, Bertrand Napoleon, Arthur LaQuiere, Stephane Koch, Geoffroy Vanbiervliet, Jean-Michel Gonzalez, Marc Barthet, Marc Giovannini, Mohamed Gasmi, Nathalie Lesavre, Christian Boustière, Bertrand Napoleon, Arthur LaQuiere, Stephane Koch, Geoffroy Vanbiervliet, Jean-Michel Gonzalez

Abstract

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features or high-risk stigmata (WF/HRS) has been evaluated in few series with short-term outcomes. This study's primary endpoint was to assess the long-term efficacy of EUS-RFA in patients with NETs or pancreatic cystic neoplasms (PCNs) over at least 3 years. Patients and methods Twelve patients had 14 NETs with a mean 13.4-mm size (10-20) and 17 patients had a cystic tumor (16 IPMN, 1 MCA) with a 29.1-mm mean size (9-60 were included. They were treated with EUS-guided RFA, evaluated prospectively at 1 year, and followed annually for at least 3 years. Results The mean duration of follow-up was 42.9 months (36-53). Four patients died during follow-up (17-42 months) from unrelated diseases. At 1-year follow-up, and 85.7 % complete disappearance was seen in 12 patients with 14 NETs. At the end of follow-up (45.6 months), complete disappearance of tumors was seen in 85.7 % of cases. One case of late liver metastasis occurred in a patient with initial failure of EUS-RFA. At 1-year follow-up, a significant response was seen in 70.5 % of 15 patients with PCNs. At the end of the follow-up, there was a significant response in 66.6 % with no mural nodules. Two cases of distant pancreatic adenocarcinoma unrelated to IPMN occurred. Conclusions EUS-RFA results for pancreatic NETs or PCNs appear to be stable during 42 months of follow-up.

Conflict of interest statement

Competing interests Dr. Barthet received a research grant from Boston scientific (endoscopic gastrojejunal anastomosis). Dr. Napoleon is a consultant for Boston Scientific.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Figures

Fig. 1
Fig. 1
EUS-guided RFA for IPMN with mural nodules.aEUS view showing a large IPMN with mural nodules located in the body of the pancreas.bCEH EUS showing enhancement of the mural nodules.cFollow-up at 42 months after EUS-RFA showing no disappearance of the cystic lesion but complete disappearance of mural nodules.dFollow-up at 42 months with CEH EUS showing no enhancement of mural nodule.
Fig. 2
Fig. 2
EUS-guided RFA with CEH control for NET located to the body of the pancreas. a EUS view of NET located to the body of the pancreas, 11 mm size, homogenous. b EUS view of NET with fine doppler showing peripheral arterial vascularization. c CEH EUS view of NET showing early hyperenhancement. d immediate CEH EUS view of NET after EUS-RFA showing no more enhancement of the treated NET.

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