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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1243-E1251
DOI: 10.1055/a-1221-5012
Review

Efficacy of EUS-RFA in pancreatic tumors: Is it ready for prime time? A systematic review and meta-analysis

Amaninder Dhaliwal
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Sindhura Kolli
2   Department of Bariatrics, NYU Langone Medical Center, New York, New York, United States
,
Banreet Singhg Dhindsa
3   Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Jacqueline Choa
3   Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, United States
,
Harmeet Singh Mashiana
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Daryl Ramai
4   Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, United States
,
Saurabh Chandan
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Neil Bhogal
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Harlan Sayles
5   Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Ishfaq Bhat
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Shailender Singh
1   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Douglas G. Adler
6   University of Utah School of Medicine, Gastroenterology and Hepatology, Salt Lake City, Utah, United States
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Abstract

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) can be used in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). We performed a systematic review and meta-analysis to evaluate the efficacy of EUS-RFA in treatment of locally advanced unresectable PDAC and other pancreatic tumors.

Patients and methods A comprehensive search was done of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of EUS-RFA for pancreatic lesions. The primary outcome was to evaluate technical and clinical success of the procedure. The secondary outcome was to study overall adverse events (AEs).

Results Thirteen studies reporting 165 EUS-RFA procedures on 134 patients were included. Of 134 patients, 27.94 % (38) had unresectable locally advanced PDAC, 40 % (53) had PNETs, 3 % (4) had metastasis to the pancreas and 30 % (41) had other lesions. The pooled technical success rate calculated out of the total number of procedures was 100 % (95 % CI [99.18 – 100], I2 = 0 %). The pooled clinical success rate calculated out of the total number of patients was 91.58 % (95 % CI [82.5 – 98.08], I2 = 21.5 %). The pooled overall AE rates were 14.67 % (95 % CI [4.77 – 27.46], I2 = 56.19 %) out of which abdominal pain was the most common with 9.82 % (95 % CI [3.34 – 18.24], I2 = 23.76 %). Low to moderate heterogeneity was noted.

Conclusion EUS-RFA has high technical (100 %) and clinical success (91.5 %) rates. Further multicenter trials are needed to further validate our findings.



Publication History

Received: 16 April 2020

Accepted: 12 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Barthet M, Giovannini M, Lesavre N. et al. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study. Endoscopy 2019; 51: 836-842
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology. Pancreatic adenocarcinoma.Version 2. 2016 http://wwwnccnorg/professionals/physician_gls/pdf/pancreaticpdf
    PubMedSearch in Google Scholar
  • 3 Scopelliti F, Pea A, Conigliaro R. et al. Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer. Surg Endosc 2018; 32: 4022-4028
    CrossrefPubMedSearch in Google Scholar
  • 4 Song TJ, Seo DW, Lakhtakia S. et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc 2016; 83: 440-443
    CrossrefPubMedSearch in Google Scholar
  • 5 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals Int Medic 2009; 151: 264-269
    CrossrefPubMedSearch in Google Scholar
  • 6 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    CrossrefPubMedSearch in Google Scholar
  • 7 Choi JH, Seo DW, Song TJ. et al. Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors. Endoscopy 2018; 50: 1099-1104
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 De la Serna C, Cimavilla M, Madrigal B. et al. Su1384 EUS-Guided radiofrequency ablation (EUS-RFA) for pancreatic neuroendocrine tumors and cystic mucinous neoplasms: a pilot study of safety, feasibility and efficacy. Gastrointest Endosc 2018; 87: AB332-AB333
    CrossrefPubMedSearch in Google Scholar
  • 9 Crino SF, D'Onofrio M, Bernardoni L. et al. EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success. J Gastrointestin Liver Dis 2018; 27: 67-72
    CrossrefPubMedSearch in Google Scholar
  • 10 Lakhtakia S, Ramchandani M, Galasso D. et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 2016; 83: 234-239
    CrossrefPubMedSearch in Google Scholar
  • 11 Oleinikov K, Dancour A, Epshtein J. et al. Endoscopic ultrasound-guided radiofrequency ablation: a new therapeutic approach for pancreatic neuroendocrine tumors. J Clin Endocrinol Metab 2019; 104: 2637-2647
    CrossrefPubMedSearch in Google Scholar
  • 12 Thosani N, Sharma NR, Raijman I. et al. 483 Safety and efficacy of endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) in the treatment of pancreatic lesions: a multi-center experience. Gastrointest Endosc 2018; 87: AB84
    CrossrefPubMedSearch in Google Scholar
  • 13 Goyal D, Cen P, Wray CJ. et al. 1111 Feasibility, Safety, and efficacy of endoscopic ultrasound (eus) guided radiofrequency ablation (RFA) of the pancreatic lesions: single center US experience. Gastrointest Endosc 2017; 85: AB144
    CrossrefPubMedSearch in Google Scholar
  • 14 Malikowski T, Gleeson FC, Block M. et al. Mo1268 Endoscopic ultrasound guided radiofrequency ablation (EUS-RFA): initial assessment of safety and efficacy. Gastrointest Endosc 2017; 85: AB484
    CrossrefPubMedSearch in Google Scholar
  • 15 Pai M, Habib N, Senturk H. et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg 2015; 7: 52-59
    CrossrefPubMedSearch in Google Scholar
  • 16 Wang D, Jin Z, Lei W. et al. Mo1524 endoscopic ultrasound guided radiofrequency ablation for the treatment of advanced pancreatic carcinoma. Gastrointest Endosc 2013; 77: AB414
    CrossrefPubMedSearch in Google Scholar
  • 17 Barret M, Leblanc S, Rouquette A. et al. EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model. Endosc Int Open 2019; 7: E138-E143
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedSearch in Google Scholar
  • 19 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. Chichester: Wiley; 2000
    Search in Google Scholar
  • 20 Higgins JPT, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    Search in Google Scholar
  • 21 Kanwal F, White D. “Systematic Reviews and Meta-analyses” in clinical gastroenterology and hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186
    CrossrefPubMedSearch in Google Scholar
  • 22 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
    CrossrefPubMedSearch in Google Scholar
  • 23 Larghi A, Rizzatti G, Rimbaş M. et al. EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: Who should we treat?. Endosco Ultrasound 2019; 8: 220-226
    CrossrefPubMedSearch in Google Scholar