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Endoscopic radiofrequency ablation excels for pancreatic tumors


 

REPORTING FROM ACG 2019

– Endoscopic ultrasound-guided radiofrequency ablation is ready for a prime time proper definitive test in a randomized controlled trial for treatment of unresectable pancreatic tumors, Amaninder Dhaliwal, MD, declared at the annual meeting of the American College of Gastroenterology.

Dr. Amaninder Dhaliwal, gastroenterology fellow at the University of Nebraska, Omaha Bruce Jancin/MDedge News

Dr. Amaninder Dhaliwal

He backed this assertion by presenting his meta-analysis of 13 published studies of endoscopic ultrasound radiofrequency ablation (EUS-RFA) therapy applied to 127 patients with unresectable pancreatic tumors. Most of the studies were small, single center, and prospective, with a mean 5.2 months of follow-up. Fifty-three percent of the patients had locally advanced unresectable pancreatic ductal adenocarcinoma and 30% had pancreatic neuroendocrine tumors, with a smattering of rarer pancreatic tumors making up the balance. The median lesion size was 28.2 mm. The majority of target lesions were located on the pancreatic head.

EUS-RFA is a relatively new approach to the treatment of unresectable pancreatic tumors. It’s a minimally invasive treatment strategy guided by high-quality, real-time imaging. The meta-analysis demonstrated that the technical and clinical success rates of the EUS-RFA procedures were high and the safety profile was impressive, especially compared to the widely used alternative of surgically assisted RFA, according to Dr. Dhaliwal, a gastroenterology fellow at the University of Nebraska, Omaha.

The patients collectively underwent 156 EUS-RFA procedures, with a 98% technical success rate. The pooled clinical success rate was 84.5% as defined by reduction in lesion size, symptomatic improvement, and radiologic evidence of necrosis on imaging the day following the procedure.

”Symptoms improved as early as the next day, including hypoglycemia in patients with insulinomas,” he said.

The 7-day early adverse event rate was 13.4%, with mild to moderate abdominal pain accounting for nearly three-quarters of such events. Notably, no perforations or infections occurred. Late adverse events consisted of two cases of jaundice, two cases of mild pancreatitis, one duodenal stricture, and one cystic fluid pocket.

All of the studies utilized specialized 18- or 19-gauge needle electrodes. The mean energy delivered was 30 watts.

“I think [these] data give us some hope that we can go forward with multicenter trials in patients with unresectable pancreatic cancer and benign lesions. These patients are very sick and have limited options,” Dr. Dhaliwal observed.

He reported no financial conflicts regarding his study.

SOURCE: Dhaliwal A. ACG Abstract 30.

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