Elsevier

Gastrointestinal Endoscopy

Volume 83, Issue 2, February 2016, Pages 440-443
Gastrointestinal Endoscopy

New methods
Clinical endoscopy
Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer

https://doi.org/10.1016/j.gie.2015.08.048Get rights and content

Background and Aims

Radiofrequency ablation (RFA) has been used as a valuable treatment modality for various unresectable malignancies. EUS-guided radiofrequency ablation (EUS-RFA) of the porcine pancreas was reported to be feasible and safe in our previous study, suggesting that EUS-RFA may be applicable as an adjunct and effective alternative treatment method for unresectable pancreatic cancer. This study aimed to assess the technical feasibility and safety of EUS-RFA for unresectable pancreatic cancer.

Methods

An 18-gauge endoscopic RFA electrode and a radiofrequency generator were used for the procedure. The length of the exposed tip of the RFA electrode was 10 mm. After insertion of the RFA electrode into the mass, the radiofrequency generator was activated to deliver 20 to 50 W ablation power for 10 seconds. Depending on tumor size, the procedure was repeated to sufficiently cover the tumor.

Results

EUS-RFA was performed successfully in all 6 patients (median age 62 years, range 43-73 years). Pancreatic cancer was located in the head (n = 4) or body (n = 2) of the pancreas. The median diameter of masses was 3.8 cm (range 3cm-9cm). Four patients had stage 3 disease, and 2 patients had stage 4 disease. After the procedure, 2 patients experienced mild abdominal pain, but there were no other adverse events such as pancreatitis or bleeding.

Conclusions

EUS-RFA could be a technically feasible and safe option for patients with unresectable pancreatic cancer.

Section snippets

Patients and methods

We obtained permission from the Institutional Review Board of each center and performed prospective data collection. A total of 6 consecutive patients were included in the study between February 2013 and March 2014. The inclusion criteria were (1) histologically confirmed pancreatic cancer, (2) unresectable stage due to locally advanced or metastasis disease, and (3) resistance to a previous treatment modality. The exclusion criteria were (1) advanced heart or lung disease precluding adequate

Results

EUS-RFA was performed successfully on all 6 patients. The median age of the patients was 62 years (range 43-73 years), and the male to female ratio was 1:5 (Table 1). Pancreatic cancer was located in the pancreas head in 4 patients and in the pancreas body in 2 patients. The median diameter of the tumor was 3.8 cm (range 3-9 cm). All of the pancreatic cancers were unresectable; 4 patients had locally advanced disease and 2 had metastasis. After the procedure, 2 patients experienced mild

Discussion

Until now, the feasibility and safety of EUS-RFA for the treatment of advanced pancreatic cancer has not been addressed. EUS can be used to target the area of ablation, and it ensures safety by avoiding damage to the surrounding structure.3 Our preliminary experience demonstrated that EUS-RFA for pancreatic cancer was well-tolerated and had no significant adverse events.6

The pancreas is a highly thermosensitive organ, and the thermal ablation of normal pancreatic tissue may lead to inflammation

References (14)

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DISCLOSURE: This study was supported by a grant (2014-201) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea (Dr Seo). All authors disclosed no financial relationships relevant to this publication.

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