Post written by Hoonsub So, MD, from the Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea, Sung Woo Ko, MD, PhD, from the Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, and Do Hyun Park, MD, PhD, from the Department of Internal Medicine, University of Ulsan College of Medicine,  Asan Medical Center, Seoul, South Korea.

This study aimed to compare EUS-guided ethanol ablation (EUS-EA) and surgical resection for nonfunctioning small pancreatic neuroendocrine tumors (PNETs).

We used the propensity score matching (PSM) method to evaluate safety outcomes of EUS-EA compared with surgical management for patients with nonfunctioning PNETs <2 cm. The primary outcome was the rate of early and late adverse events.

The secondary outcomes were disease-specific survival rates, length of hospitalization, and development of endocrine pancreatic insufficiency. Those with functional PNETs and/or insufficient follow-up data were excluded. PSM yielded 89 matched pairs of patients.  

Treatment strategies for nonfunctioning small PNETs <2 cm, especially those 1 to 2 cm, are still under debate. Some advocates choose to wait and see, but some prefer surgery.

Recent studies suggest local ablation by EUS-EA or radiofrequency ablation, but there was no comparative study on surgery. Therefore, we designed a comparative study using PSM.

EUS-EA was associated with a significantly lower rate of early major adverse events (0% vs 11.2%, P = .003). Late major adverse events occurred more frequently after surgery, with no significant difference between the groups (3.4% vs 10.1%, P = .07). The length of hospital stay was significantly shorter in the EUS-EA group (4 days vs 14.1 days, P < .001), and endocrine pancreatic insufficiency was less common after EUS-EA than after surgery (33.3% vs 48.6%, P = .121).

The treatment modalities showed comparable 10-year overall and disease-specific survival rates. Therefore, we concluded a superior safety profile in the EUS-EA group versus the surgery group, with similar overall survival outcomes.

There is no standard protocol and dedicated device for EUS-EA. We hope well-designed prospective studies with standardized follow-up protocol for EUS-EA in patients with nonfunctioning small PNETs can provide more evidence in this field. Comparison of outcomes of EUS-EA and EUS-guided radiofrequency ablation for patients with nonfunctioning small PNETs may be further considered.

A, Disease-specific survival in the main cohort. B, Disease-specific survival in the matched cohort.

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