CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1754-E1758
DOI: 10.1055/a-1261-9359
Review

Endoscopic ultrasound-guided radiofrequency ablation of pancreatic neuroendocrine tumors: a case series

Germana de Nucci
1   Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
,
Nicola Imperatore
2   Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
3   Gastroenterology and Endoscopy Unit, AORN A Cardarelli, Naples, Italy
,
Enzo Domenico Mandelli
1   Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
,
Franca di Nuovo
4   Pathology Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
,
Corrado d’Urbano
5   Surgery Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
,
Gianpiero Manes
1   Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
› Author Affiliations

Abstract

Background and study aims Surgery is the considered the therapeutic cornerstone for pancreatic neuroendocrine tumors (P-NETs), although burdened by high risk of significant adverse events. Recently, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been described for P-NETs. We aimed to evaluate the effectiveness and safety of EUS-RFA for treatment of P-NETs.

Patients and methods We prospectively included all consecutive patients with P-NET ≤ 20 mm who were treated with EUS-RFA and were followed-up for at least 12 months.

Results Ten patients (5 males, mean age 78.6 years, mean body mass index 28.2) with 11 P-NETs (mean size 14.5 mm; range 9 – 20 mm) localized in the pancreatic head (3 lesions), pancreatic body (5 lesions), and tail (3 lesions) underwent complete EUS ablation with one session of RFA. Complete ablation of P-NET was reached using a single-session RFA with a mean of 2.3 treatment applications per session. At both 6 – and 12-months computed tomography scans, all the patients had complete disappearance of lesions with radiological normalization. Regarding safety, only two cases of mild abdominal pain were recorded in two subjects with pancreatic head lesion, which were effectively treated with analgesics. The mean duration of hospital stay was 4 days (range 3 – 7 days).

Conclusions EUS-RFA is effective and safe in treating P-NETs. It may be considered an effective therapeutic option in the treatment of small P-NETs independently from their functional status.



Publication History

Received: 16 April 2020

Accepted: 18 August 2020

Article published online:
17 November 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Fitzgerald TL, Hickner ZJ, Schmitz M. et al. Changing incidence of pancreatic neoplasms: a 16-year review of statewide tumor registry. Pancreas 2008; 37: 134-138
  • 2 Lee DW, Kim MK, Kim HC. Diagnosis of pancreatic neuroendocrine tumors. Clin Endosc 2017; 50: 537-545
  • 3 Sachs T, Pratt WB, Callery MP. et al. The incidental asymptomatic pancreatic lesion: nuisance or treat?. J Gastrointest Surg 2009; 13: 405-415
  • 4 Rossi S, Viera FT, Ghittoni G. et al. Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas 2014; 43: 938-945
  • 5 Armellini E, Crinò SF, Ballarè M. et al. Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor. Endoscopy 2015; (Suppl. 01) 47
  • 6 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
  • 7 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
  • 8 Waung JA, Todd JF, Keane MG. et al. Successful management of a sporadic pancreatic insulinoma by endoscopic ultrasound–guided radiofrequency ablation. Endoscopy 2016; 48 (Suppl. 01) E144-E145
  • 9 Bas-Cutrina F, Bargalló D, Gornals JB. Small pancreatic insulinoma: Successful endoscopic ultrasound–guided radiofrequency ablation in a single session using a 22–G fine needle. Dig Endosc 2017; 29: 636-638
  • 10 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
  • 11 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
  • 12 Gueneau de Mussy P, Lamine F, Godat S. et al. A case of benign insulinoma successfully treated with endoscopic ultrasound guided radiofrequency ablation. Endocrine Abstr 2018; 56: 121
  • 13 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
  • 14 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
  • 15 Yao JC, Hassan M, Phan A. et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008; 26: 3063-3072
  • 16 Halfdanarson TR, Rubin J, Farnell MB. et al. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endocrine tumors. Endocr Relat Cancer 2008; 15: 409-427
  • 17 Hallet J, Law CH, Cukier M. et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer 2015; 121: 589-597
  • 18 Hill JS, McPhee JT, McDade TP. et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer 2009; 115: 741-751
  • 19 Jilesen AP, van Eijck CH, in't Hof KH. et al. Postoperative complications, in-hospital mortality and 5-year survival after surgical resection for patients with a pancreatic neuroendocrine tumor: a systematic review. World J Surg 2016; 40: 729-748
  • 20 Belfiori G, Wiese D, Partelli S. et al. Minimally invasive versus open treatment for benign sporadic insulinoma comparison of short-term and long-term outcomes. World J Surg 2018; 42: 3223-3230
  • 21 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?. Endosc Ultrasound 2019; 8: 220-226