Radiology, Nuclear Medicine and Imaging; Gastroenterology
Abstract :
[en] BACKGROUND AND AIMS: Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are precancerous cystic lesions. Surgery is advised for high-risk stigmata (HRS) or multiple worrisome features (WFs), but it entails substantial morbidity, and many resections reveal only low-grade dysplasia. EUS-guided radiofrequency ablation (EUS-RFA) is a minimally invasive alternative, yet long-term data are limited.
METHODS: We retrospectively analyzed a prospectively maintained cohort of consecutive patients who underwent EUS-RFA for BD-IPMNs with WFs/HRS at a tertiary referral center (2015-2024). Eligible patients were inoperable or declined surgery. Outcomes included technical success, adverse events (AEs), local control (defined as resolution of WFs/HRS with no cancer arising from the treated lesion), radiologic response, and pancreas-wide events.
RESULTS: Fifty patients (62 procedures; 58 lesions) were treated. Mean follow-up was 4.1 ± 2.8 years after radiofrequency ablation. Technical success was 100%. AEs occurred in 27% of procedures, mostly mild abdominal pain; postprocedural pancreatitis occurred in 3 patients, including 1 case of necrotizing pancreatitis; there were no procedure-related deaths. Local control was achieved in 98% of lesions; 17% showed complete radiologic disappearance, and 86% decreased in size. No treated lesion progressed to cancer. Pancreas-wide disease control was maintained in 80% of patients; 4 (8%) patients developed pancreatic cancer remote from the treated cyst. Smaller cyst size and fewer WFs were associated with better outcomes.
CONCLUSIONS: EUS-RFA is feasible, safe, and provides durable local control of BD-IPMNs with WFs/HRS in patients who are unsuitable for surgery or who decline resection. These results support EUS-RFA as a promising therapeutic option in carefully selected patients. Larger prospective studies are needed to refine selection criteria and confirm long-term oncologic benefits.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Barras, Julien ✱; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive ; Service de Gastroentérologie et Endoscopie, Hôpital Nord, Faculté de médecine Aix-Marseille, Ap-HM, Marseille, France
Lorenzo, Diane ✱; Service de Gastroentérologie et Endoscopie, Hôpital Nord, Faculté de médecine Aix-Marseille, Ap-HM, Marseille, France. Electronic address: diane.lorenzo@gmail.com
Gasmi, Mohamed; Service de Gastroentérologie et Endoscopie, Hôpital Nord, Faculté de médecine Aix-Marseille, Ap-HM, Marseille, France
Gonzalez, Jean Michel; Service de Gastroentérologie et Endoscopie, Hôpital Nord, Faculté de médecine Aix-Marseille, Ap-HM, Marseille, France
Barthet, Marc; Service de Gastroentérologie et Endoscopie, Hôpital Nord, Faculté de médecine Aix-Marseille, Ap-HM, Marseille, France
✱ These authors have contributed equally to this work.
Language :
English
Title :
Endoscopic ultrasound-guided radiofrequency ablation for intraductal papillary mucinous neoplasms with worrisome features: long-term outcomes in nonsurgical patients (with video).
Ohtsuka T, Fernandez-del Castillo C, Furukawa T, Hijioka S, Jang JY, Lennon AM, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. mars 2024;24(2):255-270.
Farges O, Bendersky N, Truant S, Delpero JR, Pruvot FR, Sauvanet A. The Theory and Practice of Pancreatic Surgery in France. Ann Surg. nov 2017;266(5):797-804.
Jang JY, Kim SW, Lee SE, Yang SH, Lee KU, Lee YJ, et al. Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe? Ann Surg Oncol. janv 2008;15(1):199-205.
Lorenzo D, Aguilera Munoz L, Vedie AL, Prat F, Dokmak S, Sauvanet A, et al. Mural nodules and prevalence of high-grade dysplasia in branch duct intraductal papillary mucinous neoplasm of the pancreas undergoing resection. Br J Surg. 27 nov 2024;111(12):znae292.
Zelga P, Hernandez-Barco YG, Qadan M, Ferrone CR, Kambadakone A, Horick N, et al. Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm. Journal of the American College of Surgeons. juin 2022;234(6):1021-1030.
Oyama H, Tada M, Takagi K, Tateishi K, Hamada T, Nakai Y, et al. Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms. Gastroenterology. janv 2020;158(1):226-237.e5.
Song YJ, Huh G, Kim EH, Lee JB, Park DH. Comparison of outcomes of EUS-guided ablation and surveillance only for pancreatic cystic lesions: a propensity score-matching study (with videos). Gastrointest Endosc. oct 2023;98(4):585-596.e3.
Ardeshna DR, Woods E, Tsung A, Krishna SG. An update on EUS-guided ablative techniques for pancreatic cystic lesions. Endoscopic Ultrasound. nov 2022;11(6):432-441.
Barthet M, Giovannini M, Lesavre N, Boustiere C, Napoleon B, Koch S, et al. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study. Endoscopy. sept 2019;51(09):836-842.
Barthet M, Giovannini M, Gasmi M, Lesavre N, Boustiere C, Napoleon B, et al. Long-term outcome after EUS-guided radiofrequency ablation: Prospective results in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms. Endosc Int Open. aout 2021;09(08):E1178-85.
Cho SH, Seo DW, Oh D, Song TJ, Lee SK. Long-Term Outcomes of Endoscopic Ultrasound-Guided Ablation Vs Surgery for Pancreatic Cystic Tumors. Clinical Gastroenterology and Hepatology. aout 2024;22(8):1628-1636.e4.
Wehrle CJ, Hossain MS, Perlmutter B, Chang JH, Joyce D, Simon R, et al. Consequences of a Surveillance Strategy for Side-branch Intraductal Pancreatic Mucinous Neoplasms: Long-term Follow-up of One Thousand Cysts. Ann Surg. 1 oct 2024;280(4):683-692.
McCleary-Wheeler AL, McWilliams R, Fernandez-Zapico ME. Aberrant signaling pathways in pancreatic cancer: a two compartment view. Mol Carcinog. janv 2012;51(1):25-39.
Nass KJ, Zwager LW, van der Vlugt M, Dekker E, Bossuyt PMM, Ravindran S, et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc. juin 2022;95(6):1078-1085.e8.
Pai M. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. WJGS. 2015;7(4):52.
Choi JH, Seo DW, Song TJ, Park DH, Lee SS, Lee SK, et al. Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors. Endoscopy. nov 2018;50(11):1099-1104.
Patel V, Shah ZK, Hart P, Culp S, Shah H, Shah R, et al. S4 Safety and Efficacy of Endoscopic Ultrasound-Guided Radiofrequency Ablation for Branch Duct-Intraductal Papillary Mucinous Neoplasms: A Single Arm Clinical Trial. Official journal of the American College of Gastroenterology | ACG. oct 2024;119(10S):S2.
DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointestinal Endoscopy. 1 oct 2009;70(4):710-723.
Gomez V, Takahashi N, Levy MJ, McGee KP, Jones A, Huang Y, et al. EUS-guided ethanol lavage does not reliably ablate pancreatic cystic neoplasms (with video). Gastrointest Endosc. mai 2016;83(5):914-920.
Younis F, Ben-Ami Shor D, Lubezky N, Geva R, Osher E, Shibolet O, et al. Endoscopic ultrasound-guided radiofrequency ablation of premalignant pancreatic-cystic neoplasms and neuroendocrine tumors: prospective study. European Journal of Gastroenterology & Hepatology. nov 2022;34(11):1111.
Oh HC, Seo DW, Song TJ, Moon SH, Park DH, Soo Lee S, et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology. janv 2011;140(1):172-179.
Attila T, Adsay V, Faigel DO. The efficacy and safety of endoscopic ultrasound-guided ablation of pancreatic cysts with alcohol and paclitaxel: a systematic review. European Journal of Gastroenterology & Hepatology. janv 2019;31(1):1-9.
Shockley KE, To B, Chen W, Lozanski G, Cruz-Monserrate Z, Krishna SG. The Role of Genetic, Metabolic, Inflammatory, and Immunologic Mediators in the Progression of Intraductal Papillary Mucinous Neoplasms to Pancreatic Adenocarcinoma. Cancers. janv 2023;15(6):1722.
Suh H, Pillai K, Morris DL. Mucins in pancreatic cancer: biological role, implications in carcinogenesis and applications in diagnosis and therapy. Am J Cancer Res. 1 juin 2017;7(6):1372-1383.
Ponnusamy MP, Seshacharyulu P, Lakshmanan I, Vaz AP, Chugh S, Batra SK. Emerging Role of Mucins in Epithelial to Mesenchymal Transition. Curr Cancer Drug Targets. nov 2013;13(9):945-956.
Rodriguez-Ruiz ME, Vanpouille-Box C, Melero I, Formenti SC, Demaria S. Immunological Mechanisms Responsible for Radiation-Induced Abscopal Effect. Trends Immunol. aout 2018;39(8):644-655.
Zerbini A, Pilli M, Penna A, Pelosi G, Schianchi C, Molinari A, et al. Radiofrequency thermal ablation of hepatocellular carcinoma liver nodules can activate and enhance tumor-specific T-cell responses. Cancer Res. 15 janv 2006;66(2):1139-1146.
Lambin T, Lafon C, Drainville RA, Pioche M, Prat F. Locoregional therapies and their effects on the tumoral microenvironment of pancreatic ductal adenocarcinoma. World J Gastroenterol. 7 avr 2022;28(13):1288-1303.
