7 Efficacy of Endoscopic Ultrasound Radiofrequency Ablation in the Treatment of Pancreatic Tumors: Is It Ready for Prime Time? A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Endoscopic ultrasound radiofrequency ablation (EUS-RFA) is the newer technique, which is minimally invasive, more selective and safer in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). We did systematic review and meta-analysis to evaluate the efficacy of EUS-RFA in the treatment of unresectable PDAC, pancreatic neuroendocrine tumors (PNENs) and other pancreatic tumors. METHODS: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of EUS-RFA for pancreatic lesions. The primary outcome was to evaluate technical and clinical success of the procedure. Technical success was defined as successful placement of the needle within the lesion. The clinical success was defined (a) decrease in size of lesion (b) improvement of symptoms (c) radiological evidence of necrosis status post RFA. The secondary outcome was to study overall adverse events. The meta-analysis was performed using Der Simonian and Laird random effect model. RESULTS: 13 studies reporting on 127 patients with mean age of 61.3 years were included. 156 EUS-RFA procedures were performed on 127 patients. Out of 127 patients, 67% (85) had advanced PDAC, 16% (20) PNENs and 17% (22) other pancreatic tumors. The location of tumor and clinical success rate was reported in 10 out of 13 studies. The most common location of the lesion was head (54%) followed by the body of the pancreas (35%). The pooled technical success (Figure 1) rate calculated out of the total number of procedures was 98% (95% CI = 90.69–100, I2 = 50%). The pooled clinical success rate (Figure 2) calculated out of the total number of patients was 89.46% (95% CI = 69.17–100, I2 = 77.8%). The pooled overall adverse event rates (Figure 3) were 13.40% (95% CI = 4.11–25.55, I2 = 51.80%). In subgroup analysis, abdominal pain was the most common side effect (8.81%; 95% CI = 2.72–16.88, I2 = 18.87%). Bleeding and post procedure pancreatitis were noted in one patient each. No perforation or procedure related infections were noted in our patient population. Moderate heterogeneity was noted in our study. CONCLUSION: EUS-RFA not only has high technical (98%) and clinical success (89.46%) rates but is also a safer procedure with minimal overall adverse events (13.4%). Further multi-center trials are needed to further validate our findings.