Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study

Marc Barthet; Marc Giovannini; Nathalie Lesavre; Christian Boustiere; Bertrand Napoleon; Stéphane Koch; Mohamed Gasmi; Geoffroy Vanbiervliet; Jean-Michel Gonzalez

doi:10.1055/a-0824-7067

Endoscopy, Table of Contents

Endoscopy 2019; 51(09): 836-842
DOI: 10.1055/a-0824-7067

Original article

Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study

Marc Barthet

¹Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France

,

Marc Giovannini

²Endoscopy Unit, Institut Paoli Calmettes, Marseille, France

,

Nathalie Lesavre

³Centre d’Investigation Clinique, Hôpital Nord, Marseille, France

,

Christian Boustiere

⁴Service d’Hépato-gastroentérologie, Hôpital Saint-Joseph, Marseille, France

,

Bertrand Napoleon

⁵Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France

,

Stéphane Koch

⁶Department of Gastroenterology, CHRU Minjoz, Besançon, France

,

Mohamed Gasmi

¹Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France

,

Geoffroy Vanbiervliet

⁷Centre Hospitalier Universitaire de Nice, Hôpital L’Archet 2, Nice, France

,

Jean-Michel Gonzalez

¹Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France

› Author Affiliations

Abstract

Background Pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features are surgically managed. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been developed. The safety of EUS-RFA was the primary end point of this study, its efficacy the secondary end point.

Methods This was a prospective multicenter study that was planned to include 30 patients with a 1-year follow-up with either a NET < 2 cm or a pancreatic cystic neoplasm (PCN), either a branch duct IPMN with worrisome features or a mucinous cystadenoma (MCA). EUS-RFA was performed with an 18G RFA cooling needle.

Results 12 patients had 14 NETs (mean size 13.1 mm, range 10 – 20 mm); 17 patients had cystic tumors (16 IPMNs, 1 MCA; mean size 28 mm, range 9 – 60 mm). Overall three adverse events occurred (10 %), two of these in the first two patients (one pancreatitis, one small-bowel perforation). After these initial patients, modifications in the protocol resulted in a decrease in complications (3.5 %), with one patient having a pancreatic ductal stenosis. Among the 14 NETs, at 1-year follow-up 12 had completely disappeared (86 % tumor resolution), with three patients having a delayed response. Among the 17 PCNs, at 12 months, there were 11 complete disappearances and one diameter that decreased by > 50 % (significant response rate 71 %). All 12 mural nodules showed complete resolution.

Conclusions EUS-RFA of pancreatic NETs or PCNs is safe with a 10 % complication rate, which can be decreased by improved prophylaxis for the procedure.

Full Text

References

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