Endoscopic ultrasound-guided radiofrequency for treatment of pancreatic neuroendocrine tumors: follow-up and safety of the procedure

Aims Endoscopic ultrasound-guided radiofrequency (EUS-RFA) for treatment of pancreatic neuroendocrine tumors (pNET) is developing as an alternative to surgery. EUS-RFA is a safe and effective treatment for tumors smaller than 2 cm [1] [2]. The aim of our work is to evaluate the side effects and long-term follow-up of these patients.

Methods This is a retrospective study of patients treated with EUS-RFA between December 2015 and June 2024 at two tertiary and expert centers for the management of pNET. Grade 1 histological confirmation was obtained prior to treatment. Technical success was defined as the possibility of performing radiofrequency treatment. Clinical success was defined as the disappearance of lesions and/or contrast enhancement on follow-up imaging. We used the AGREE classification for adverse events [3].

Results 107 patients were included (50.5% male, mean age=62.9 years). 91 patients (85%) had a non-functional pNET (nfNET), including 36 (34%) with a cystic component. A functional tumor (fNET) was identified in 16 patients (15%). The mean size was 13.2 mm (range 5 mm – 27 mm) and 100 (93.5%) of patients had a single lesion. The mean number of EUS-RFA per patient was 1.3 (range 1 -3). The technical success rate was 100%, and the clinical success rate was 73.8% (n=79) at the first session, and 98.1% (n=105) overall for an average session rate of 2.4 (range 2-3). 12 (11.2%) patients had a grade III complication. They required endoscopic management for ductal stenosis by endocanal biliary drainage or drainage of pancreatic collection. Eventually, one patient required surgery for recurrent collections. No procedure-related deaths were reported. No recurrences were recorded, with a mean follow-up of 1.9 years (median 1.6 years, range 0.06 years-7.9 years).

Conclusions Our study is currently the largest series of patients to have undergone EUS-RFA for pNETs and confirms excellent technical and clinical efficacy, combined with a superior safety profile to surgery. Long-term monitoring in this study is also important, confirming the efficacy of this treatment and long-term eradication.

Publication History

Article published online:
27 March 2025

• References

• 1 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointestinal Endoscopy 2022; 95: 1078-1085.e8
• 2 Marx M, Trosic-Ivanisevic T, Caillol F. et al. EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers. Gastrointest Endosc 2022; 95: 1256-1263
• 3 Marx M, Godat S, Caillol F. et al. Management of non-functional pancreatic neuroendocrine tumors by endoscopic ultrasound-guided radiofrequency ablation: Retrospective study in two tertiary centers. Dig Endosc 2022; 34: 1207-1213