Endoscopic ultrasound-guided radiofrequency ablation for pancreatic cystic neoplasms: a comprehensive review

The detection of pancreatic cystic lesions (PCLs) is increasingly common, with certain subtypes like intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) carrying malignant potential. Current management, based on risk-stratified guidelines, faces challenges including imperfect specificity of high-risk features, surgical overtreatment, and the burden of long-term surveillance. For high-risk patients unfit for surgery, the traditional surgery or surveillance paradigm is inadequate, driving the need for minimally invasive therapies. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) merges precise targeting with thermal ablation, emerging as a promising local treatment option for PCLs. This review aims to systematically explore the technical principles, device evolution, and standardized operational procedures of EUS-RFA. It will provide a detailed analysis of its current clinical application status, efficacy, and safety evidence across different pathological types of PCLs, and highlight its unique advantages and applicable scenarios through a comparative analysis with EUS-guided chemical ablation. Finally, this article will examine the current challenges facing this technology and prospect its future development directions. Comprehensive existing evidence suggests that EUS-RFA has evolved from a prospective technology into an important therapeutic option characterized by high efficacy, safety, and minimal invasiveness for carefully selected PCLs with malignant potential. However, the full establishment of its clinical value still relies on the accumulation of higher-level evidence-based data and further standardization in the future.