Published online Jan 7, 2023. doi: 10.3748/wjg.v29.i1.157
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.
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.