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From binary to gradient: EUS-RFA redefines primary aldosteronism therapy.

Zhixin Xu1, Jing Chang2

  • 1Department of Cardiovascular Medicine, Cardiovascular Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

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Summary
This summary is machine-generated.

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a new gradient approach for pancreatic ablation (PA) treatment. EUS-RFA shows promising remission rates, presenting an alternative to traditional medical or surgical interventions.

Keywords:
Digital hypertensionImplemental hypertensionMorning hypertensionPrimary aldosteronism

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Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Endoscopy
  • Oncology

Background:

  • Pancreatic ablation (PA) treatment traditionally relied on a binary approach: surgery or medication.
  • Minimally invasive techniques are increasingly explored to improve PA treatment outcomes and patient recovery.
  • Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a novel therapeutic option.

Discussion:

  • EUS-RFA represents a significant advancement, offering a less invasive option within a spectrum of treatments that now includes ablation, medication, and surgery.
  • The FABULAS trial (Argentesi et al., The Lancet 2025) demonstrated notable efficacy for EUS-RFA in pancreatic ablation.
  • Comparing outcomes highlights the evolving landscape of PA treatment options.

Key Insights:

  • EUS-RFA achieved 75% biochemical remission and 43% clinical remission in the FABULAS trial.
  • Medical treatment (PAMO criteria) showed a 52.9% biochemical response and 18.3% clinical response.
  • Surgery (PASO criteria) reported the highest remission rates at 94% biochemical and 84% clinical remission.

Outlook:

  • EUS-RFA expands the therapeutic armamentarium for pancreatic conditions, providing a valuable intermediate option.
  • Further research will likely refine the role of EUS-RFA within the gradient treatment paradigm.
  • Optimizing patient selection for ablation, medical, or surgical interventions will be crucial for personalized PA management.