Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and endoscopic ultrasound-guided ethanol ablation (EUS-EA) of pancreatic neuroendocrine tumors and adenocarcinoma: a prospective multicenter study

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Okasha H.H.; Altonbary A.Y.; Ragab K.; Ghoneem E.; Tag-Adeen M.; Abdellatef A.; Naguib M.S.; Miutescu B.; Gadour E.

Journal: Przeglad Gastroenterologiczny

Publisher: Termedia Publishing House Ltd.

Publication Date: 2025

Volume / Issue: Volume 20 / Issue 2

Pages: 158–164

ISSN: 18955770

DOI: 10.5114/pg.2025.151852

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Okasha H.H., Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Cairo University, Cairo, Egypt; Altonbary A.Y., Department of Gastroenterology and Hepatology, Mansoura University, Mansoura, Egypt; Ragab K., Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Giza, Egypt; Ghoneem E., Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Tag-Adeen M., Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena, Egypt; Abdellatef A., Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt; Naguib M.S., Department of Gastroenterology, Ahmed Maher Teaching Hospital, Cairo, Egypt; Miutescu B., Department of Gastroenterology and Hepatology Victor Babes, University of Medicine and Pharmacy, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; Gadour E., Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia, Department of Medicine, Faculty of Medicine, Zamzam University College, Khartoum, Sudan

Abstract

Introduction: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and endoscopic ultrasound-guided ethanol ablation (EUS-EA) are emerging novel methods for managing non-functioning and functioning pNET and adenocarcinoma in the pancreas. Aim: To assess the safety profile, feasibility, and outcomes of EUS-RFA and EUS-EA of focal pancreatic masses. Material and methods: This prospective study included 27 patients, 15 males and 12 females, with a mean age of 36.38 years. EUS-RFA was carried out in 13 patients; 11 had pancreatic insulinoma, and 2 had advanced pancreatic adenocarcinoma. The mean size of the masses was 20.6 mm, while that of the insulinomas was 17.4 mm. The median number of needle passes was 3, with a range of 1 to 6. RFA was conducted using 19G EUSRA needles from Taewoong Co., Ltd., South Korea. No minor or major complications were observed. EUS-EA was carried out in 14 patients, all of whom had pancreatic insulinoma. The mean size of the masses was 15.3 mm. The median number of needle passes was 2, with a range of 1 to 3. We used 19G and 22G echo tip FNA needles from Cook Company, USA. The mean duration of follow-up was 12.4 months. There was mild to moderate acute pancreatitis in 4 patients in the EUS-EA group; all were relieved by conservative therapy, and no hospital admission was required. No early or late significant complications were reported in the EUS-RFA group. Results: There was a complete clinical cure of 10 out of 11 (91%) patients with pancreatic insulinoma who underwent EUS-RFA. However, 1 patient required three sessions, and 2 patients required two sessions of EUS-RFA. The 11th patient with insulinoma showed a poor response after the first session, then a partial response after the second session of EUS-RFA. The size of the two masses with advanced adenocarcinoma was decreased, but no downstaging of the masses was achieved. There was a complete clinical cure of 8 out of 14 (57%) patients with pancreatic insulinoma who underwent EUS-EA. No clinical cure was observed in 4 patients; 3 underwent major surgery, and the 4th one underwent EUS-RFA. The last 2 patients showed a partial clinical response with decreased frequency, duration, and severity of hypoglycemic attacks. They were managed by diet regulation; no major surgery was needed. Conclusions: EUS-RFA and EUS-EA can potentially treat lesions and control symptoms. EUS-RFA is a more promising and safer technique for managing functioning insulinomas. However, it cannot downstage pancreatic ductal adenocarcinoma patients. EUS-EA seems less efficient, with more adverse events than EUS-RFA. © 2025 Termedia Publishing House Ltd.. All rights reserved.

Keywords

endoscopic ultrasound-guided ethanol ablation; endoscopic ultrasound-guided radiofrequency ablation; EUS-RFA; insulinoma; pancreatic neuroendocrine tumors; alcohol; ablation therapy; adult; Article; chemoradiotherapy; clinical article; conservative treatment; endoscopic ultrasonography; ethanol ablation; feasibility study; female; fine needle aspiration biopsy; follow up; hospital admission; human; major surgery; male; multicenter study; pancreas adenocarcinoma; pancreas islet cell tumor; patient safety; radiofrequency ablation

Citation Information

Scopus Citations: 1

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