SAFETY AND EFFICACY OF ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION (EUS-RFA) OF PANCREATIC CYSTIC NEOPLASMS (PCNS) AND PANCREATIC NEUROENDOCRINE TUMORS (PNETS): PRELIMINARY REPORT OF A PROSPECTIVE COHORT

Aims:

To assess the safety and efficacy of EUS guided RFA for the treatment of pancreatic lesions, initial experience of a prospective cohort.

Methods:

Patients with intraductal papillary mucinous neoplasm (IPMN) or mucinous cysts with worrisome features who were not eligible or refused surgery, as well as patients with grade 1 PNETs less than 2 cm were offered the option of RFA. Ablation was performed using a 19-gauge dedicated needle with a 1 cm long active cooled tip. The volume of PCNs was reduced with a FNA needle before the procedure. The delivery of energy was monitored by continuously monitoring tissue conductivity, and the formation of bubbles on the ultrasound image.

Results:

Eight patients were treated so far, 2 males and 6 females, average age was 73.5. Five had PCNs with a mean size of 36 mm (12 – 60) and three were treated for non-secreting PNETs with a mean size of 10 mm (7 – 16). Average CEA levels in PCNs was 1731, and average chromogranin levels was 234 in PNETs. Three patients reported abdominal pain after the procedure and median serum amylase level was 99 a day after the procedure. Of the 5 patients with PCNs 2 had complete resolution of their cysts at 6 months, 1 needed another RFA intervention, and had complete resolution of his cyst after 9 months, 2 have not reached 6 months follow-up yet. Six months follow-up for PNETs is not yet available.

Conclusions:

Nine ablations in 8 patients were preformed since November 2017. Safety profile was excellent with only mild post-procedural abdominal pain reported, and only one patient with biochemical pancreatitis treated conservatively. Three patients had complete resolution of their cysts so far. EUS guided RFA seems to be a safe method for the treatment of pancreatic lesions, and efficacious for the treatment PCNs.