Endoscopic ablation therapy for the pancreatic neoplasms

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy
• Oncology

Background:

• Endoscopic ultrasound (EUS)-guided ablation therapy offers a less invasive treatment option for pancreatic neoplasms.
• Common techniques include injective ablation (e.g., ethanol) and radiofrequency ablation (RFA).

Purpose of the Study:

• To evaluate the effectiveness of EUS-guided ablation therapies for pancreatic neoplasms, including solid and cystic types.
• To compare the efficacy of EUS-guided ethanol ablation (EUS-EA) and EUS-guided radiofrequency ablation (EUS-RFA).

Main Methods:

• Review of existing literature on EUS-guided ablation techniques for pancreatic neoplasms.
• Analysis of reported complete response (CR) rates and adverse events (AEs) for EUS-EA and EUS-RFA.

Main Results:

• EUS-EA reported CR rates of 60-80% for solid neoplasms; EUS-RFA reported 55-100% CR rates with no additional AEs.
• Both therapies showed excellent success in ameliorating insulinoma symptoms.
• EUS-RFA demonstrated superiority over EUS-EA in complete tumor ablation, though its effectiveness for pancreatic cancers remains inadequate.
• EUS-guided injection ablation therapy for pancreatic cystic neoplasms (PCNs) showed CR rates from 35% to 79%; alcohol-free agents were effective with low AEs.
• Limited studies exist on EUS-RFA for PCNs.

Conclusions:

• EUS-guided ablation therapies, particularly EUS-RFA, are promising for managing pancreatic neoplasms.
• Further research is needed, especially on EUS-RFA for PCNs.
• EUS-guided ablation therapy is poised for wider adoption in treating malignant and potentially malignant pancreatic lesions.