Gastrointestinal endoscopy · 2026
Endoscopic ultrasound-guided radiofrequency ablation for intraductal papillary mucinous neoplasms with worrisome features: long-term outcomes in nonsurgical patients (with video).
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Barras Julien, Lorenzo Diane, Gasmi Mohamed, Gonzalez Jean Michel, Barthet Marc
Аннотация
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.
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.