Letter to the Editor: Reconsidering relevance of endoscopic ultrasound-guided radiofrequency ablation in pancreatic cancer treatment: Future perspectives on artificial intelligence

Table 1 Outline of challenges, risks and suggestive remarks

Challenges		Risk	Suggestive remarks
Technical	Lack of target specific optimized parameters for RFA	Complications including thermal injury	Development of AI-integrated target specific RFA modality
Procedure-related	Inter-operator variability, dependency on interventional endoscopist skills	Thermal injury, pancreatitis, collateral damage may cause bleeding, infection, perforation	Require highly skilled interventional endoscopist, AI-EUS integration for guidance[2], development of AI + EUS + RFA system
	Safety of vascular structures	Damage of vascular structures near ablation	High resolution colour Doppler guidance[3]
Precision	Probe FOV constrain	Irregular or small tumours may miss, suboptimal execution of procedure, chances of recurrence	Multiangle scanning, use of contrast-enhanced EUS for functional unambiguity and targeting of ROI, confirmations through multi-modalities such as MRI, CT. If needed, multiple episodes of procedure may execute
Investigative	Lack of standardized protocol for combination therapy	Suboptimal therapeutic response, recurrence	A large sample sized, RCT required, to assess comparative efficacy of treatment response and survival benefits, involving combination therapy e.g., immunotherapy and/or chemotherapy, with EUS-RFA procedure[1]
Financial	Costly	Less generalized reach for patients in under-resourced regions	Development of cost-effective system

AI: Artificial intelligence; RFA: Radiofrequency ablation; EUS: Endoscopic ultrasound; FOV: Field of view; ROI: Region of interest; RCT: Randomized controlled trial; MRI: Magnetic resonance imaging; CT: Computed tomography.