ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (On-Demand)

Pausawasdi_EUS.Ablation

Pdf Summary

EUS Ablation, or endoscopic ultrasound ablation, is a minimally invasive procedure used to treat certain types of tumors in the pancreas. There are two main techniques used in EUS Ablation: ethanol injection (EUS-FNI) and radiofrequency ablation (EUS-RFA). Ethanol injection involves injecting ethanol into the tumor to destroy it, while radiofrequency ablation uses high-frequency electrical currents to heat and destroy the tumor.<br /><br />EUS-Ethanol injection is mainly used for functional pancreatic neuroendocrine tumors (insulinoma) and non-functional neuroendocrine tumors larger than 2cm. The technique involves injecting ethanol into the tumor using a needle, guided by endoscopic ultrasound. The success rate of EUS-Ethanol injection varies among studies, with some reporting complete tumor response and others reporting adverse events such as abdominal pain or pancreatitis.<br /><br />EUS-RFA is indicated for locally advanced pancreatic tumors, including neuroendocrine tumors and pancreatic adenocarcinoma. The procedure involves using a radiofrequency electrode to deliver controlled heat to the tumor and destroy it. The success rates of EUS-RFA vary, but studies have reported technical success rates of 96.7% and clinical success rates of 82.2%. Adverse events can occur, including pancreatitis, pancreatic duct stricture, bleeding, gut wall necrosis, and vascular thrombosis.<br /><br />To minimize adverse events during EUS Ablation, precautions such as avoiding ablation outside the tumor to protect the normal pancreas, placing a prophylactic pancreatic stent if the tumor is close to the main pancreatic duct, checking doppler signals to avoid damage to blood vessels, and avoiding catheter tip abutment to vessels should be taken.<br /><br />Overall, EUS Ablation has shown acceptable success rates in selected cases of pancreatic tumors. However, standardization of techniques and further studies are needed to fully assess its efficacy and safety.

Keywords

EUS Ablation

endoscopic ultrasound ablation

pancreatic tumors

ethanol injection

radiofrequency ablation

neuroendocrine tumors

pancreatic adenocarcinoma

adverse events

precautions

efficacy