PDF | https://doi.org/10.46613/congastro2023-129
This work is licensed under CC BY 4.0
CASTRO M1, VARGAS J1, VILLALOBOS Á1, HERNÁNDEZ D1, CAMPOS C1, COSTE P1, GUTIÉRREZ C1, REZVANI F1, AVENDAÑO G1, OCHOA A1
1Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
Introduction: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a minimally invasive treatment modality for solid pancreatic tumors such as pancreatic neuroendocrine neoplasms (p-NEN) and unresectable pancreatic cancer (PC).
Aims: assess safety and efficacy of pancreatic EUS RFA therapy in a large case series of patients with p-NEN and unresectable PC in three high volume hospital centers in Costa Rica.
Methods: This retrospective study included all consecutive patients who underwent pancreatic EUS RFA between May 2020-April 2023. Indications, procedural characteristics, early and late adverse events, and clinical outcomes were recorded. Technical success rate was defined as successful access with the 19-gauge needle into pancreatic neoplasm and feasibility of EUS-RFA, and clinical success as complete or partial radiological response for non-functioning p-NEN (NF-NEN), and resolution of symptoms for insulinomas. Patients with pancreatic cancer were excluded. Major and minor postprocedural adverse effects were assessed.
Results: 45 ablations were performed in 29 patients, of whom 15 were PC (N=13 locally advanced and N=2 metastatic) and 14 were p-NEN (N=8 NF and N=6 insulinomas). Sixty-nine percent (N=20) were female, with a median age of 58 years (IQR:12-83). Median lesion diameter was 30 mm (IQR:10-80). Clinical and procedure-related characteristics are summarized in Table 1. The technical success rate was 100%. In the subgroup of patients with p-NEN clinical success was complete and partial in 57% and 43%, respectively; with a complete clinical response of hypoglycemia in 83% (N=5/6) of insulinomas in the first 48 hours. The adverse event rate was 14% (N=4), with mild pancreatitis being the most frequent. No serious adverse events or procedure-related deaths occurred. All patients with PC underwent concomitant chemotherapy within two days after ablation.
Conclusions: EUS-RFA is a technically feasible treatment with a good safety profile for the management of solid pancreatic tumors (PC and p-NEN).
