ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (Virtual)

Pausawasdi_EUS.Ablation

Pdf Summary

The document discusses EUS ablation, specifically focusing on EUS-FNI (ethanol injection) and EUS-RFA (radiofrequency ablation), for the treatment of various pancreatic tumors. The presentation provides information on the indications, techniques, outcomes, and measures to prevent adverse events for both EUS-FNI and EUS-RFA.<br /><br />For EUS-FNI, the document discusses its use in functional NET (insulinoma) and non-functional NET (>2cm) cases. The technique involves injecting ethanol into the tumor, monitoring the response with contrast-enhanced harmonic EUS, and ensuring the complete ablation of the tumor. Various studies have reported high success rates with EUS-FNI, although adverse events like pancreatitis and bleeding should be prevented.<br /><br />EUS-RFA is discussed as a treatment option for locally advanced pancreatic tumors, including both neuroendocrine tumors (PNETs) and pancreatic adenocarcinoma (PDAC). The installation process and technique of EUS-RFA are described, and the use of enhanced harmonic EUS is recommended for better visualization. The document also highlights the need to prevent adverse events such as pancreatitis, pancreatic duct stricture, bleeding, gut wall necrosis, and vascular thrombosis during EUS-RFA.<br /><br />The outcomes of EUS-RFA for PNETs and PDAC are presented based on systematic reviews and meta-analyses. The technical and clinical success rates for both tumor types are reported to be high, although adverse events like abdominal pain are observed in a small percentage of cases.<br /><br />In conclusion, EUS ablation techniques show promise in the treatment of solid pancreatic tumors. However, standardization of techniques and more studies are needed to further establish their efficacy and safety profiles.

Keywords

EUS ablation

EUS-FNI

EUS-RFA

pancreatic tumors

ethanol injection

radiofrequency ablation

adverse events

PNETs

PDAC

efficacy