Departments of Gastroenterology and Liver Disease.
Surgery.
Eur J Gastroenterol Hepatol. 2022 Nov 1;34(11):1111-1115. doi: 10.1097/MEG.0000000000002422. Epub 2022 Sep 10.
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a developing therapeutic approach for premalignant pancreatic-cystic neoplasms (PCNs) and small pancreatic neuroendocrine tumors (PNETs). The safety and efficacy of pancreatic EUS-RFA were previously reported in small series. Herein we report our initial experience with RFA of PCNs and small PNETs.
This is a prospective single-center study including 12 patients with a median follow-up of 7 months, with either PCN or PNET <2 cm. Eligible PCNs were either intraductal papillary mucinous neoplasms (IPMN) with worrisome features or mucinous cystic neoplasms (MCN) that were not eligible or refused surgery. Ablation was performed using a 19-gauge dedicated needle.
Twelve patients were treated, five had PCNs (four IPMNs, one MCN; median size of 36 mm, range 12-60) and seven had PNETs (median size 8.9 mm, range 6-18). Among patients with PCNs, the complete radiologic response was achieved in 3/5 (60%), partial response in 1/5 (20%) and failure in 1/5 (20%). Among six patients with nonfunctioning PNETs, the complete radiologic response was achieved in 4/6 (66.7%), partial radiologic response in 0/6 (0%) and failure in 2/6 (33.3%). Following a median follow-up of 7 months. One patient with insulinoma showed complete resolution of hypoglycemia-related symptoms. Three postprocedural adverse events occurred, including one case (1/12, 8.3%) of mild acute pancreatitis and two cases (2/12, 16.7%) of abdominal pain.
EUS-guided RFA for premalignant PCNs and PNETs is feasible and well-tolerated. Efficacy would be further evaluated with continued follow-up of patients.
内镜超声引导下射频消融术（EUS-RFA）是一种治疗癌前胰腺囊性肿瘤（PCN）和小胰腺神经内分泌肿瘤（PNET）的新兴治疗方法。以前的小系列研究报告了胰腺 EUS-RFA 的安全性和有效性。在此，我们报告了我们对 PCN 和小 PNET 进行 RFA 的初步经验。
这是一项前瞻性单中心研究，纳入了 12 例中位随访时间为 7 个月的患者，他们均患有 <2cm 的 PCN 或 PNET。符合条件的 PCN 为有危险特征的导管内乳头状黏液性肿瘤（IPMN）或不符合手术条件或拒绝手术的黏液性囊性肿瘤（MCN）。消融采用 19 号专用针进行。
共治疗了 12 例患者，其中 5 例患有 PCN（4 例 IPMN，1 例 MCN；中位大小为 36mm，范围 12-60），7 例患有 PNET（中位大小为 8.9mm，范围 6-18）。在 PCN 患者中，完全放射学反应在 3/5 例（60%）中达到，部分反应在 1/5 例（20%）中达到，失败在 1/5 例（20%）中达到。在 6 例无功能 PNET 患者中，完全放射学反应在 4/6 例（66.7%）中达到，部分放射学反应在 0/6 例（0%）中达到，失败在 2/6 例（33.3%）中达到。中位随访 7 个月后，1 例胰岛素瘤患者低血糖相关症状完全缓解。术后发生了 3 例不良事件，包括 1 例（1/12，8.3%）轻度急性胰腺炎和 2 例（2/12，16.7%）腹痛。
EUS 引导下 RFA 治疗癌前 PCN 和 PNET 是可行的，且患者耐受良好。随着对患者的进一步随访，将评估疗效。
