EUS-guided radiofrequency ablation of unresectable pancreatic cancer

Song_headshotTae Jun Song, MD, PhD, and Dong Wan Seo, MD, PhD, from the Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center in Seoul, South Korea presents this New Methods article, “Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer.”

We investigated the feasibility and safety of endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) for unresectable pancreatic cancer.

Pancreatic cancer carries a poor prognosis and only one fifth of patients present with resectable disease. With chemotherapy or chemo-radiation therapy, most unresectable pancreatic cancer patients experienced only a small benefit. RFA is considered a safe and potentially curative method and has been widely used for the treatment of various tumors, but not of the pancreas. EUS-guided RFA allows real-time imaging of the pancreas mass where RFA may result in safe tissue ablation. According to our previous animal study, EUS-guided RFA was feasible and safe for the porcine pancreas.

Song_fig
Figure 2. Imaging of EUS-guided radiofrequency and follow-up contrast-enhanced EUS. A, EUS-guided radiofrequency ablation (RFA) was performed from the duodenal bulb with 50 W of ablation power for 10 seconds and was repeated 6 times. B, After RFA, contrast-enhances EUS showed a nonenhanced central necrotic portion (arrowhead) and increased blood flow at the peripheral site (arrow).

A total of 6 consecutive patients were included in the study between February 2013 and March 2014. After insertion of the RFA electrode into the mass, the RF generator was activated to deliver 20−50 W ablation power. The ablation was performed for 10 seconds at one site and was repeated until the hyperechoic zone around the electrode tip sufficiently covered the tumor. EUS-guided RFA was successfully performed in all patients in whom pancreatic cancer was located in the head (n=4) or body (n=2) of the pancreas. After the procedure, two patients experienced mild abdominal pain, but there were no serious adverse events such as pancreatitis or bleeding. EUS-guided RFA can be a technically feasible and safe option for patients with an unresectable pancreatic cancer.  EUS-RFA may be used as an adjunct and effective alternative treatment method for unresectable pancreatic cancer.

Find the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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