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World J Gastroenterol. Jan 7, 2023; 29(1): 157-170
Published online Jan 7, 2023. doi: 10.3748/wjg.v29.i1.157
Endoscopic ultrasound guided radiofrequency ablation for pancreatic tumors: A critical review focusing on safety, efficacy and controversies
Tawfik Khoury, Wisam Sbeit, Bertrand Napoléon
Tawfik Khoury, Wisam Sbeit, Department of Gastroenterology, Galilee Medical Center, Nahariya 2210001, Israel
Bertrand Napoléon, Department of Endoscopy Unit, Private Hospital Jean Mermoz, Lyon 69008, France
Author contributions: Napoléon B and Khoury T contributed to study design; all authors contributed to the data collection; Napoléon B and Khoury T contributed to the critical revision of the manuscript; and all authors approved the final version to be published.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Tawfik Khoury, MD, Assistant Professor, Doctor, Senior Lecturer, Department of Gastroenterology, Galilee Medical Center, Meona Street, Nahariya 2210001, Israel.
Received: September 26, 2022
Peer-review started: September 26, 2022
First decision: October 18, 2022
Revised: October 21, 2022
Accepted: December 13, 2022
Article in press: December 13, 2022
Published online: January 7, 2023

The role of endoscopic ultrasound (EUS) in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreato-biliary disorders. In recent years, its applications for treating pancreatic diseases have broadened, including the implementation of radiofrequency ablation (RFA), which has been traditionally used for treating solid tumors. In this critical in-depth review, we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms, adenocarcinoma, and pancreatic cystic lesions. Overall, for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA, with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%. For pancreatic adenocarcinoma, we identified 8 papers with 121 patients. Adverse events occurred in 13% of patients, mostly rated mild. However, no clear survival benefit was demonstrated. For pancreatic cystic lesions, we identified 4 papers with 38 patients. The adverse events were mostly mild and occurred in 9.1% of patients, and complete or partial radiological resolution of the cysts was reported in 36.8%. Notably, the procedure was technically feasible for most of the patients. Nevertheless, a long road remains before this technique finds its definite place in guidelines due to several controversies. EUS-RFA for pancreatic tumors seems to be safe and effective, especially for pancreatic neuroendocrine neoplasms, but multicenter prospective trials are needed to consider this treatment as a gold standard.

Keywords: Endoscopic ultrasound, Radiofrequency ablation, Efficacy, Safety, Pancreas, Tumors

Core Tip: Endoscopic ultrasound guided radiofrequency ablation has been increasingly implemented in the treatment of pancreatic neoplasms. We reviewed the role of endoscopic ultrasound guided radiofrequency ablation in the treatment of pancreatic neuroendocrine tumors, unresectable pancreatic adenocarcinoma, and pancreatic cystic lesions, focusing on efficacy, safety, and controversies. We found that endoscopic ultrasound guided radiofrequency ablation was feasible with an excellent technical success, acceptable adverse events, and a beneficial effect for pancreatic neuroendocrine tumors, mainly on insulinoma. While its effect on pancreatic adenocarcinoma and cystic lesions is promising, more studies are needed to better explore its role.