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• W4223561419 abstract "For nearly 3 decades, endosonographers have considered whether EUS can be used not only for diagnostic purposes but also to direct therapy. Since the late 1990s, EUS-guided intratumoral therapies (EUS-ITT) to include photodynamic therapy, cryotherapy, implantation of brachytherapy seeds, direct injection of chemotherapy agents, alcohol ablation, and most recently radiofrequency ablation (RFA) have been used to treat solid pancreatic tumors.1Artifon E.L. Lucon A.M. Sakai P. et al.EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma.Gastrointest Endosc. 2007; 66: 1201-1205Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 2Hecht J.R. Bedford R. Abbruzzese J.L. et al.A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma.Clin Cancer Res. 2003; 9: 555-561PubMed Google Scholar, 3Jin Z. Du Y. Li Z. et al.Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study.Endoscopy. 2008; 40: 314-320Crossref PubMed Scopus (154) Google Scholar, 4Yusuf T.E. Matthes K. Brugge W.R. EUS-guided photodynamic therapy with verteporfin for ablation of normal pancreatic tissue: a pilot study in a porcine model (with video).Gastrointest Endosc. 2008; 67: 957-961Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar, 5Carrara S. Arcidiacono P.G. Albarello L. et al.Endoscopic ultrasound-guided application of a new internally gas-cooled radiofrequency ablation probe in the liver and spleen of an animal model: a preliminary study.Endoscopy. 2008; 40: 759-763Crossref PubMed Scopus (36) Google Scholar Safe and effective oncologic therapies are needed to destroy tumor cells and associated desmoplasia without damaging adjacent normal tissues. With RFA ablative therapy, an electrode introduces alternating electric currents at a frequency of 3 Hz to 300 GHz. Dipole molecules of tissue adjacent to the electrode continually realign themselves in the direction of the alternating current. These rapid movements result in molecular friction and subsequent focal thermogenesis with coagulation necrosis.6Hong K. Georgiades C. Radiofrequency ablation: mechanism of action and devices.J Vasc Interv Radiol. 2010; 21: S179-S186Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar Whereas there was certainly initial excitement regarding the use of RFA as an adjunctive therapy for pancreatic ductal adenocarcinoma (PDAC), the limited data thus far have been disappointing, and there is no convincing evidence that RFA has any notable impact on survival or other meaningful endpoint.7Pezzilli R. Serra C. Ricci C. et al.Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review.Pancreas. 2011; 40: 163-165Crossref PubMed Scopus (27) Google Scholar This lack of benefit for PDAC is largely expected, given the tumor biology and the presence of early metastasis that are unlikely to be overcome by the purported immune response associated with RFA. Thus, EUS-RFA has largely been limited to other tumor types such as pancreatic neuroendocrine tumors (pNETs), for which local therapies are more apt to provide benefit. Although insulinomas are the most common pNETs, they are rare, having an incidence of 0.4 in 100,000, and only a subset require treatment.8Mathur A. Gorden P. Libutti S.K. Insulinoma.Surg Clin North Am. 2009; 89: 1105-1121Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar In 2016, the European Neuroendocrine Tumor Society provided guidelines for insulinoma management and recommended that treatment be considered for tumors that are nonmetastatic, >2 cm, associated with multiple endocrine neoplasia type 1, or cause persistent symptoms. They suggested laparoscopic surgery with enucleation or, if necessary, extended resection.9Falconi M. Eriksson B. Kaltsas G. et al.ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors.Neuroendocrinology. 2016; 103: 153-171Crossref PubMed Scopus (755) Google Scholar Although surgical management of pNETs is highly effective, there is an approximately 30% risk of morbidity.10Su A.P. Ke N.W. Zhang Y. et al.Is laparoscopic approach for pancreatic insulinomas safe? Results of a systematic review and meta-analysis.J Surg Res. 2014; 186: 126-134Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar A few reports highlight the potential role of EUS-RFA for insulinomas, predominantly among poor operative candidates. In this issue of Gastrointestinal Endoscopy, Marx et al11Marx M. Trosic-Ivanisevic T. Caillol F. et al.EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers.Gastrointest Endosc. 2022; 95: 1256-1263Abstract Full Text Full Text PDF Scopus (5) Google Scholar report their experience with EUS-RFA for treating 7 patients with insulinomas. In this 2-center study, candidates for EUS-RFA were patients who had lesions that were isolated, sporadic, and <2 cm; who experienced symptomatic hypoglycemia, and who were poor operative candidates or declined oncologic resection. All lesions were treated by use of an EUS-RFA system developed by Taewoong Medical (STARmed, TaeWoong Medical, South Korea). The tumors measured 13.3 mm (range, 8 to 20 mm) and were treated with the 10-mm electrode. The authors delivered 1 to 5 cycles using 50 watts for a maximum of 10 seconds or until hyperechoic bubbles were visualized. Two of the insulinomas were close to the superior mesenteric vein. In 1 patient, the tumor was close to the main pancreatic duct (PD), for which the authors performed ERCP and PD stent placement with intent to decrease the risk of pancreatitis. The authors reported that all 7 patients had immediate and persistent post-RFA euglycemia and a median follow-up time of 21 months. They also highlighted that for 6 patients, cross-sectional imaging demonstrated complete resolution of the insulinoma, and for 4 patients the lesion had completely disappeared after 1 treatment. Regarding adverse events, the patient who had a PD stent placed required a 3-day hospitalization for postprocedure pancreatitis. A second patient experienced fever and abdominal pain, which were treated with antibiotics for 1 week in the outpatient setting. A third patient experienced severe necrotizing pancreatitis that resulted in death soon after the patient declined further therapy. The authors should be congratulated for their work, which highlights the potential role of EUS-RFA in managing insulinomas. However, there is ongoing uncertainty regarding the entire field of EUS-ITT, with little growth in the science and application over the past few decades. We limit our discussion to insulinomas, which likely constitute the least controversial indication. For full disclosure, the authors of this editorial perform EUS-ITT, including RFA, and we believe that such techniques are vastly underutilized. Our forthcoming comments are not intended to be critical to Marx et al11Marx M. Trosic-Ivanisevic T. Caillol F. et al.EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers.Gastrointest Endosc. 2022; 95: 1256-1263Abstract Full Text Full Text PDF Scopus (5) Google Scholar inasmuch as we have produced our own marginally informative small studies.12Rustagi T. Gleeson F.C. Abu Dayyeh B.K. et al.Evaluation of effects of radiofrequency ablation of ex vivo liver using the 1-Fr wire electrode.J Clin Gastroenterol. 2018; 52: 168-171Crossref PubMed Scopus (4) Google Scholar, 13Levy M.J. Thompson G.B. Topazian M.D. et al.US-guided ethanol ablation of insulinomas: a new treatment option.Gastrointest Endosc. 2012; 75: 200-206Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 14Levy M.J. Alberts S.R. Bamlet W.R. et al.EUS-guided fine-needle injection of gemcitabine for locally advanced and metastatic pancreatic cancer.Gastrointest Endosc. 2017; 86: 161-169Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Despite several studies, EUS-RFA is regarded as a novelty by most practitioners and not a truly viable option in the management of insulinomas. This cannot be explained simply by the rarity of insulinomas, given that the limited use of EUS-RFA applies to all pancreatic tumor types. There are likely many overlapping reasons to account for the limited acceptance of EUS-RFA treatment of insulinomas, including the following:1.Limited data from studies with often insufficient methodology, including limited enrollment and short follow-up times. As in the referenced study, key details are often missing that would aid our understanding of the appropriateness of care and the need and potential benefit of EUS-RFA. For instance, knowledge of the pre- and post-RFA dose of antihypoglycemic agents, presence and severity of neurologic (neuroglycopenic) and sympathoadrenal (autonomic) manifestations, serum blood sugar nadir and ranges, and assessment of quality of life would have helped place the study findings into greater context. In addition, EUS therapeutic studies are likely heavily biased in terms of enrollment without a clear understanding of the inclusion and exclusion criteria. For instance, we recently declined RFA for a small tumor on the caudal aspect of the pancreas deep to the splenic artery, for which an adequate acoustic window could not be achieved. RFA would have provided incomplete therapy with a greater risk of adverse events. Small retrospective nonconsecutive case series typically do not provide such details.2.Nonstandardized technique for performing EUS-RFA. There are 3 needle options (5-, 7-, or 10-mm) providing different size ablative zones that are selected on the basis of tumor size. In the referenced study, the tumors measured 13.3 mm (range, 8 to 20 mm); interestingly, regardless of size, each tumor was treated with the 10-mm electrode. The authors delivered 1 to 5 cycles using 50 watts for a maximum of 10 seconds or until hyperechoic bubbles were visualized. These practices also vary among studies and from what the device manufacturer’s marketing literature recommends. In fact, the device company’s promotional material has varied over time, with several different power settings and cycle durations recommended. The informational materials have also varied as to the size of the ablative zone, despite the same power setting and cycle duration. Given that lesions as small as 8 mm were included in this study, surrounding normal pancreatic tissue may be damaged by the reported 7 × 12 mm ablative zone, which some indicate is 6.1 × 14.3 mm at the same settings. Marx et al11Marx M. Trosic-Ivanisevic T. Caillol F. et al.EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers.Gastrointest Endosc. 2022; 95: 1256-1263Abstract Full Text Full Text PDF Scopus (5) Google Scholar made no reference to the selected mode of ablation and did not mention the use of impedance lockout, the threshold at which the cycle duration and ablation are automatically terminated. The significance of the hyperechoic bubbles is also unclear. The authors relied on the appearance of hyperechoic bubbles to determine cycle duration, whereas in other studies, ablation continued until the bubbles escaped the target lesion. The hyperechoic bubbles are an expected byproduct of tissue vaporization and for some are not considered to be a determinate of cycle duration regardless of pattern and extent of spread. Studies demonstrate that the hyperechoic zone is an inaccurate correlate for total ablation area.15Yao Z. Wu T. Zheng B. et al.A novel strategy for single-session ultrasound-guided radiofrequency ablation of large benign thyroid nodules: a pilot cohort study.Front Endocrinol (Lausanne). 2020; 11: 560508Crossref PubMed Scopus (7) Google Scholar, 16Shi J.W. Huang Y. Comparison of the ablation and hyperechoic zones in different tissues using microwave and radio frequency ablation.J Ultrasound Med. 2019; 38: 2611-2619Crossref PubMed Scopus (3) Google Scholar, 17Zhou Z. Wu S. Wang C.Y. et al.Monitoring radiofrequency ablation using real-time ultrasound Nakagami imaging combined with frequency and temporal compounding techniques.PLoS One. 2015; 10e0118030Google Scholar Additionally, hyperechoic bubbles generate significant posterior acoustic enhancement, limiting full evaluation of the ablation zone. However, treatment can continue because the bubbles disperse typically within 1 to 2 minutes.3.Inconsistent metrics of success and differences in the way particular metrics are assessed. Should we rely on symptoms, antihypoglycemic drug requirements, blood sugar levels, chromogranin A levels, radiographic changes of enhancement, or tumor disappearance of decreased size? Some studies surprisingly report complete disappearance of solid tumors ≥2 cm. In our experience, even among patients with a complete and enduring clinical and laboratory response, the insulinoma typically loses enhancement and may decrease in size, but rarely do such tumors fully disappear. Also, it is unclear whether loss of enhancement equates with resulting tumor necrosis or simply cellular injury, which may suffice if the goal is simply resolution of hypoglycemia and associated manifestations. In this situation, the technique may favor a less aggressive approach that minimizes risk to healthy parenchyma. Others worry that partially treated lesions may still hold malignant potential, and they advocate more aggressive ablative measures. For those who rely on changes in tumor enhancement, little is said regarding the need and accuracy of pancreatic protocol CT, lesser-quality CT, other cross-sectional imaging, or contrast-enhanced EUS.4.Safety, which in this study, with its mild-to-moderate adverse event rate, was similar to that of laparoscopic surgery. We must also consider the risk associated with unrecognized incomplete ablation and needle track seeding. Whereas Marx et al11Marx M. Trosic-Ivanisevic T. Caillol F. et al.EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers.Gastrointest Endosc. 2022; 95: 1256-1263Abstract Full Text Full Text PDF Scopus (5) Google Scholar advocate treatment regardless of the proximity of the pancreatic duct or major vessels, others consider these findings contraindications to EUS-RFA. Owing to concerns about post-RFA pancreatitis, the authors chose to place a PD stent periprocedurally. Cannulation of a nondilated PD and otherwise healthy gland risks pancreatitis, which must be factored into the decision making.18Freeman M.L. Overby C. Qi D. Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success.Gastrointest Endosc. 2004; 59: 8-14Abstract Full Text Full Text PDF PubMed Scopus (174) Google Scholar One must also consider the potential need for stent exchange in patients requiring multiple EUS-RFA sessions that may span several weeks to months. As demonstrated in this study, there is unclear benefit of PD stenting, given that the patient who received a stent was hospitalized for 4 days with post-RFA pancreatitis. Existing studies have also failed to account for the varying heat sink effect of tumors based on their specific degree of vascularity. We do not purport to know the answers to these technical issues, but they raise uncertainty among those who perform RFA and those considering adoption of RFA into their practice.5.Lack of direct comparative data for EUS-RFA versus EUS-guided alcohol injection, for which the efficacy and safety are likely comparable, which is a presumption that needs to be studied.19Bas-Cutrina F. Bargallo D. Gornals J.B. Small pancreatic insulinoma: successful endoscopic ultrasound-guided radiofrequency ablation in a single session using a 22-G fine needle.Dig Endosc. 2017; 29: 636-638Crossref PubMed Scopus (22) Google Scholar, 20Choi J.H. Seo D.W. Song T.J. et al.Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors.Endoscopy. 2018; 50: 1099-1104Crossref PubMed Scopus (45) Google Scholar, 21de Nucci G. Imperatore N. Mandelli E.D. et al.Endoscopic ultrasound-guided radiofrequency ablation of pancreatic neuroendocrine tumors: a case series.Endosc Int Open. 2020; 8: E1754-E1758Crossref PubMed Scopus (0) Google Scholar, 22Furnica R.M. Deprez P. Maiter D. et al.Endoscopic ultrasound-guided radiofrequency ablation: an effective and safe alternative for the treatment of benign insulinoma.Ann Endocrinol (Paris). 2020; 81: 567-571Crossref PubMed Scopus (6) Google Scholar, 23Lakhtakia S. Ramchandani M. Galasso D. et al.EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos).Gastrointest Endosc. 2016; 83: 234-239Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar, 24Oleinikov K. Dancour A. Epshtein J. et al.Endoscopic ultrasound-guided radiofrequency ablation: a new therapeutic approach for pancreatic neuroendocrine tumors.J Clin Endocrinol Metab. 2019; 104: 2637-2647Crossref PubMed Scopus (38) Google Scholar, 25Waung J.A. Todd J.F. Keane M.G. et al.Successful management of a sporadic pancreatic insulinoma by endoscopic ultrasound-guided radiofrequency ablation.Endoscopy. 2016; 48: E144-E145PubMed Google Scholar Alcohol injection may also be a more cost-effective approach, given the EUS-RFA–associated cost for an expensive nonreusable probe and additional capital costs for the generator. Also, alcohol is typically injected via a 22- or 25-gauge needle, which is easier for most endosonographers to skillfully handle than a stiff 19-gauge RFA probe that is stiffer than a 19-gauge needle, given that RFA probes have a solid needle design.6.Common lack of acceptance from pancreatologists, oncologists, surgeons, and funding agencies. Our lack of data and our ongoing uncertainties regarding the safety, efficacy, and role of EUS-guided ablative therapies have even greater resonance among our colleagues. Moreover, unfortunate stubborn practice patterns, disputes over management, concerns over losing patient referrals, and associated revenue loss have further hampered our efforts. By addressing the lacking data, we may slowly resolve these issues. For patients with insulinomas, the decision whether to offer typically curative surgical resection versus less invasive local therapy with EUS-RFA should also consider (1) the tumor grade, stage, and malignant potential; (2) the patient’s age, comorbid illnesses, and health status; (3) the treatment goals and whether to fully ablate or only partially ablate to provide symptom control, which may suffice given the low malignant potential; (4) the tumor morphology and pancreatic anatomic factors such as tumor location, size, shape, degree of vascularity, surrounding parenchymal composition and health, proximate and intervening structures, and risk to endocrine and exocrine dysfunction; and (5) the comparative safety and efficacy of other EUS-guided ablative modalities. While we have taken care of the low-hanging fruit, insulinomas, for which there should be the least debate regarding the role of EUS-RFA, there are more substantial uncertainties regarding a role for nonfunctioning pNETs, PDAC, pancreatic cysts, and other tumor types. Future studies should consider specific protocols for current techniques (RFA and alcohol injection) along with other new and emerging techniques. Otherwise, we will continue to be regarded as cowboys using softly proven methods, having an uncertain clinical impact for only a very small percentage of patients. We should partner with oncology, surgical, and interventional radiology colleagues to jointly develop and properly study novel, minimally invasive techniques. However, we have limited ability to answer such questions, given the rarity of the disease process and competing interests. Until then, we will rely on small studies and apply surrogate data from other tumor types and treatment modalities. Unfortunately, the same comments could have been made 20 years ago. The role of EUS in the management of oncologic diseases continues to evolve, and whereas the future is bright, there remains substantial work to be done to establish relevance and acceptance. Dr Marya is a consultant for Boston Scientific. The other author disclosed no financial relationships. EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centersGastrointestinal EndoscopyVol. 95Issue 6PreviewInsulinoma is the most frequent functional neuroendocrine tumor of the pancreas, and preserving surgery is the treatment of choice. EUS-guided radiofrequency ablation (EUS-RFA) is a novel and promising technique that induces tissue necrosis of localized lesions. This article presents a preliminary clinical experience in treating pancreatic insulinomas <2 cm by EUS-RFA, focusing on safety and efficacy. Full-Text PDF" @default.
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• W4223561419 title "EUS-guided intratumoral therapies: more time on the treadmill" @default.
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• W4223561419 cites W2020877759 @default.
• W4223561419 cites W2027409524 @default.
• W4223561419 cites W2044394586 @default.
• W4223561419 cites W2111085711 @default.
• W4223561419 cites W2225295951 @default.
• W4223561419 cites W2253896813 @default.
• W4223561419 cites W2550899530 @default.
• W4223561419 cites W2594819763 @default.
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• W4223561419 cites W3112271009 @default.
• W4223561419 cites W4200532599 @default.
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