Dhaliwal Amaninder, Kolli Sindhura, Dhindsa Banreet Singhg, Choa Jacqueline, Mashiana Harmeet Singh, Ramai Daryl, Chandan Saurabh, Bhogal Neil, Sayles Harlan, Bhat Ishfaq, Singh Shailender, Adler Douglas G
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States.
Department of Bariatrics, NYU Langone Medical Center, New York, New York, United States.
Endosc Int Open. 2020 Oct;8(10):E1243-E1251. doi: 10.1055/a-1221-5012. Epub 2020 Sep 22.
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. 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). 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. EUS-RFA has high technical (100 %) and clinical success (91.5 %) rates. Further multicenter trials are needed to further validate our findings.
内镜超声引导下射频消融术（EUS-RFA）可用于无法切除的胰腺导管腺癌（PDAC）患者。我们进行了一项系统评价和荟萃分析，以评估EUS-RFA治疗局部晚期不可切除PDAC和其他胰腺肿瘤的疗效。对多个电子数据库和会议论文集进行了全面检索，包括PubMed、EMBASE、Web of Science数据库、谷歌学术，并手动检索参考文献（从创刊至2019年5月），以确定报告使用EUS-RFA治疗胰腺病变的研究。主要结局是评估该手术的技术和临床成功率。次要结局是研究总体不良事件（AE）。纳入了13项研究，报告了对134例患者进行的165例EUS-RFA手术。在134例患者中，27.94%（38例）患有不可切除的局部晚期PDAC，40%（53例）患有胰腺神经内分泌肿瘤（PNETs），3%（4例）有胰腺转移，30%（41例）有其他病变。从手术总数计算得出的汇总技术成功率为100%（95%CI[99.18-100]，I²=0%）。从患者总数计算得出的汇总临床成功率为91.58%（95%CI[82.5-98.08]，I²=21.5%）。汇总的总体AE发生率为14.67%（95%CI[4.77-27.46]，I²=56.19%），其中腹痛最为常见，为9.82%（95%CI[3.34-18.24]，I²=23.76%）。观察到低至中度异质性。EUS-RFA具有较高的技术成功率（100%）和临床成功率（91.5%）。需要进一步的多中心试验来进一步验证我们的发现。
