Background. Pancreatic neuroendocrine tumors (NETs) are typically treated by surgery. The
surgery-associated relevant morbidity and mortality have driven alternative curative
approaches. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a novel and
promising technique that induces tissue necrosis of localized lesions. We evaluated safety,
technical success and efficacy of EUS-RFA to treat pancreatic NETs.
Method. This is a retrospective single center study. 6 patients were included with a NET < 2
cm between December 2017 and August 2019. EUS-RFA was performed with the EUSRATM 19-
gauge needle from Taewoong® with a power of 50 Watts during maximum 10 seconds in most
cases, except for one patient where we used a power of 30 Watts during 45 seconds according
to the following recommendation of the manufacturer.
Results. Mean size of NETs was 10.7mm (range 7.4-14). One NET was of grade 2 and localized
in the isthmus; five NETs were of grade 1 and localized in the uncinated process (2), in the
isthmus (1) and in the pancreatic body (2). Overall, 3 of the NETs were insulinomas. EUS-RFA
was feasible in all cases (100%). Clinical success was obtained in 5/6 patients (83.3%) without
residual tumor remnant at 12-month imaging follow-up, with a mean number of RFA sessions
of 1.17 per patient. The only patient treated with 30 Watts during 45 seconds developed a
pancreatic fistula that was treated surgically after failure of an endoscopic management. The
3 patients treated for insulinoma did not face any symptoms or hypoglycemia anymore with
an immediate effect following RFA. No significant increase in tumor markers (Chromogranin
A, Neuron-Specific Enolase, C-peptide, proinsulin) was found in any patients after the last RFA
session. Three patients experienced mild post-procedural abdominal pain treated
conservatively.
Conclusion. EUS-RFA management of pancreatic NETs <2cm seems feasible and effective.
Optimal values of RFA power and duration, safety and long-term efficacy need to be
established in further studies including larger patient samples and longer follow-up.