Aix Marseille Université, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
Endoscopy Unit, Institut Paoli Calmettes, Marseille, France.
Endoscopy. 2019 Sep;51(9):836-842. doi: 10.1055/a-0824-7067. Epub 2019 Jan 22.
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.
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.
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.
EUS-RFA of pancreatic NETs or PCNs is safe with a 10 % complication rate, which can be decreased by improved prophylaxis for the procedure.
胰腺神经内分泌肿瘤（NET）和具有令人担忧特征的导管内胰腺黏液性肿瘤（IPMN）需要手术治疗。内镜超声（EUS）引导下射频消融（RFA）最近已经得到发展。EUS-RFA 的安全性是本研究的主要终点，其疗效是次要终点。
这是一项前瞻性多中心研究，计划纳入 30 例患者，随访时间为 1 年，患者患有 NET < 2 cm 或胰腺囊性肿瘤（PCN）、具有令人担忧特征的分支胰管 IPMN 或黏液性囊腺瘤（MCA）。EUS-RFA 使用 18G RFA 冷却针进行。
12 例患者有 14 个 NET（平均大小为 13.1 mm，范围 10 至 20 mm）；17 例患者有囊性肿瘤（16 个 IPMN，1 个 MCA；平均大小为 28 mm，范围 9 至 60 mm）。总的来说，有 3 例发生不良事件（10%），其中前 2 例各有 1 例（胰腺炎 1 例，小肠穿孔 1 例）。在这两名最初的患者之后，方案的修改降低了并发症的发生率（3.5%），其中 1 例患者出现胰管狭窄。在 14 个 NET 中，在 1 年的随访中，12 个完全消失（86%的肿瘤消退），3 个患者有延迟反应。在 17 个 PCN 中，在 12 个月时，有 11 个完全消失，1 个直径减少> 50%（显著反应率为 71%）。所有 12 个壁结节均完全消退。
EUS-RFA 治疗胰腺 NET 或 PCN 是安全的，并发症发生率为 10%，通过改进预防措施可以降低并发症发生率。
