EUS-guided radiofrequency ablation of small pancreatic adenocarcinoma: a new therapeutic option for patients unfit for surgery

摘要

Radiofrequency ablation (RFA) is a well-established therapeutic option for ablation of dysplastic and neoplastic tissue by the use of local thermal coagulative necrosis. Thepercutaneous approach has been shown to be effectiveand safe, but it is unfeasible in cases of lesions with interposition of organs and/or vessels. For pancreatic lesions,surgery-assisted RFA has been described as an invasivetreatment for locally advanced pancreatic adenocarcinoma,with a substantial risk of thermal injuries to major vesselsor adjacent structures. EUS-guided RFA is a minimally invasive approach that offers high-quality real-timeimaging guidance during selective ablation of pancreaticlesions.1-4 It has been shown to be feasible and safe inpatients with unresectable pancreatic cancer.5,6 In thisvideo (Video 1, available online at www.VideoGIE.org),we present a case of EUS-guided RFA of a resectable smallpancreatic adenocarcinoma in a patient unfit for surgery.An 83-year-old patient with an incidental CT finding of a15-mm solid pancreatic lesion (Fig. 1) underwent contrastenhanced (CE) EUS, which revealed a 15-mm hypoechoicand hypoenhancing lesion of the neck of the pancreas,with irregular borders (Fig. 2A and B). EUS fine-needlebiopsy was performed with a 20-gauge fenestrated needle,and the lesion was diagnosed as an adenocarcinoma.Although there was no vascular invasion or distant metastases, the patient was judged unfit for surgery because ofmultiple severe cardiovascular comorbidities. The patientwas then referred for EUS-guided RFA of the lesion.