Post written by Muhammad Ahmad Bashir, MD, and Shailendra Singh, MD, from West Virginia University, Morgantown, West Virginia, USA.

Our video demonstrates the use of EUS-guided radiofrequency ablation (RFA) to control bleeding GI tract malignancies in 2 patients. Under real-time sonographic guidance, we advanced a RFA needle directly into the core of each malignant mass. Delivering focused thermal energy from within allowed us to coagulate deep feeding vessels responsible for active hemorrhage while simultaneously debulking tumor tissue, resulting in immediate and sustained hemostasis without procedural adverse events.

Managing bleeding GI tumors can be challenging in everyday practice. Conventional approaches such as hemostatic clips, contact thermal devices, or topical hemostatic powders are often difficult to apply effectively on friable tumor surfaces, and rebleeding remains common. When surgical intervention or embolization is not ideal, palliative options can feel limited. We wanted to share our experience using EUS to illustrate a practical alternative that focuses on coagulating deeper feeding vessels within the mass rather than relying solely on surface therapies.

To our knowledge, our article shows that EUS-guided RFA can serve as an effective, minimally invasive salvage therapy for refractory neoplastic bleeding. Endosonography provides exceptional real-time visualization, allowing clinicians to deliver precise thermal ablation within tumor boundaries while safeguarding adjacent healthy structures. We hope endoscopists consider this technique as a viable option in their palliative toolkit when conventional hemostatic measures fall short.

As interventional EUS technology continues to evolve, expanding its role from purely tissue acquisition and drainage into targeted oncologic therapeutics opens up practical, patient-centered solutions for complex GI bleeding.

Upper endoscopy demonstrating a friable, fungating malignant mass in the first portion of the duodenum with active hemorrhage.

Read the full article online.

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