Endoscopic ultrasound-guided radiofrequency ablation for large branch-duct intraductal papillary mucinous neoplasms: Safety and efficacy trial

TL;DR

This study evaluates the safety and effectiveness of a nonsurgical treatment for large pancreatic tumors using endoscopic ultrasound-guided radiofrequency ablation.

Contribution

The study presents the first prospective trial of EUS-RFA for large branch-duct intraductal papillary mucinous neoplasms.

Findings

78.6% of tumors showed at least 50% reduction in volume after treatment.

39.3% of tumors demonstrated complete (≥90%) response.

88.2% of tumors with KRAS/GNAS mutations showed loss of detectable mutations post-treatment.

Abstract

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a nonsurgical treatment option for managing pancreatic lesions. We sought to evaluate the safety and efficacy of EUS-RFA for large (≥4 cm) branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs).

Patients with a definitive diagnosis of BD-IPMN who declined or were unfit for surgery underwent EUS-RFA in a single-arm prospective trial. Ablation was performed using a 19G EUS-RFA needle. RFA applications were delivered up to a maximum threshold of 45 seconds or 400 ohms impedance. Safety was assessed using AGREE guidelines. Potential for efficacy was assessed using cyst volume and cyst fluid
KRAS GNAS
mutations using next-generation sequencing (NGS). Adverse events (AEs) were analyzed per RFA session, while response was analyzed per BD-IPMN.

Thirty BD-IPMNs (mean diameter 4.6 ± 1.7 cm; 80% multilocular) in 25 participants (mean age 74.1 ± 8.3 years) underwent 41 EUS-RFA sessions. AEs occurred in 12.2% of procedures (5/41), the majority being AGREE Grade 3A (9.8%, 4/41).

During a mean follow-up of 18 ± 5 months, 22 of 28 BD-IPMNs (78.6%) achieved ≥ 50% reduction in cyst volume, and 11 (39.3%) demonstrated complete (≥90%) response. Among 26 BD-IPMNs that revealed
KRAS GNAS
mutations, follow-up NGS was performed in 17, with 88.2% showing loss of detectable mutations.

EUS-RFA in large, predominantly multilocular BD-IPMNs shows promising volumetric efficacy. Safety may be improved through refined energy delivery and technical advances. Molecular response remains exploratory and requires further validation. Long-term studies assessing progression-free outcomes are needed to define its role as an organ-preserving therapeutic option.

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