Endoscopic ultrasound-guided treatment of pancreatic lesions

Endoscopic ultrasound (EUS) guided ablation is an evolving minimally invasive approach for treating pancreatic lesions. While current guidelines do not yet recommend routine use, EUS ablation offers targeted, organ-sparing therapy that bridges the gap between surveillance and surgical resection. Techniques are evolving but data is available for ethanol ablation, intralesional chemoablation, radiofrequency ablation, among many others. For pancreatic cystic lesions and neuroendocrine tumors, EUS ablation achieves promising complete and partial response rates and favorable safety profile. Early studies in unresectable pancreatic adenocarcinoma show technical feasibility, safety, and potential synergy with systemic therapy. This review summarizes the current literature on EUS-guided ablation, highlighting clinical outcomes, limitations, and techniques, while emphasizing the need for further research to define optimal patient selection and long-term efficacy.