EUS-GUIDED RADIOFREQUENCY ABLATION MID-TERM RESULTS (MORE THAN TWO YEARS FOLLOW-UP) FOR PANCREATIC NEUROENDOCRINE TUMOR AND PANCREATIC CYSTIC NEOPLASMS

Aims Recent management with EUS-guided RFA for pancreatic NET and IPMN was recently investigated in a multicenter prospective study, The results were provided at one year-follow-up. We decided to extent the follow-up to at least two years. The primary endpoint of the study was the efficacy of EUS-RFA and the recurrence was the secondary endpoint.

Methods 30 patients were included, with NET less than 2 cm or branch duct IPMN with worrisome features or mucinous cystadenoma.

EUS RFA was performed with a cooled 18G needle (Starmed-Taewong, Korea). The patients were prospectively followed at least 2 years.

Results The mean duration of the follow-up was 33 months (25-48). We included 12 patients with an average NET size of 13.4 mm (10 to 20 mm) and 17 patients with a cystic tumor (16 IPMN, 1 CM) with an average size of 29.1 mm (9 to 60 mm). 2 deaths occurred during the follow-up: the first due to HCC and the second due to a stroke. There was no delayed complications (including pancreatic ductal stenosis, peripancreatic collection or vascular complication).

At the end of the follow-up, 13 out 14 NET (in 12 patients) were in complete response. A non responder patient received a second session of RFA. For cystic tumors, 11 patients were in complete response, 1 patient continued to have a lesion whose diameter was reduced by more than 50%. Of the 5 patients considered as treatment failure, 2 had no change in size, 2 received a second session of RFA and one died of HCC.

No recurrence happened among patients with an initial wall nodule or wall thickening.

Conclusions Pancreatic EUS-RFA for NET or cystic tumors showed excellent results with a follow-up of more than 2 years, without delayed complication or recurrence after complete response. This data should be evaluated with a longer follow-up.