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Endoscopic Radiofrequency Ablation of the Pancreas

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Abstract

Radiofrequency ablation (RFA) is a well-established technique to ablate dysplastic and neoplastic tissue via local thermal coagulative necrosis. Despite the widespread use in management of several cancers, the application of RFA in pancreas has been limited due to the increased risks of complications from the increased sensitivity of pancreatic tissue to thermal injury and proximity to vascular and biliary structures. RFA has been successfully used during laparotomy for locally advanced pancreatic carcinoma but requires an invasive approach. Endoscopic ultrasound-guided RFA offers the best combination of excellent visualization, real-time imaging guidance, and precise localization with minimal invasiveness. Several animal and human studies have demonstrated the technical feasibility and safety of endoscopic RFA in the pancreas. This article provides a comprehensive review of endoscopic RFA in the management of pancreatic lesions.

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References

  1. McGorisk T, Krishnan K, Keefer L, et al. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc. 2013;78:584–588.

    Article  PubMed  Google Scholar 

  2. Dray X, Repici A, Gonzalez P, et al. 1040 Radiofrequency ablation treatment of gastric antral vascular ectasia: results from an international collaborative study. Gastrointest Endosc. 2013;77:AB180.

    Google Scholar 

  3. Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). Gastrointest Endosc. 2015;81:428–436.

    Article  PubMed  Google Scholar 

  4. Rustagi T, Mashimo H. Endoscopic management of chronic radiation proctitis. World J Gastroenterol. 2011;17:4554–4562.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sharma VK, Kim HJ, Das A, et al. A prospective pilot trial of ablation of Barrett’s esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). Endoscopy. 2008;40:380–387.

    Article  CAS  PubMed  Google Scholar 

  6. Sharma VK, Wang KK, Overholt BF, et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc. 2007;65:185–195.

    Article  PubMed  Google Scholar 

  7. Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wolf DS, Dunkin BJ, Ertan A. Endoscopic radiofrequency ablation of Barrett’s esophagus. Surg Technol Int. 2012;22:83–89.

    PubMed  Google Scholar 

  9. Lin ZZ, Shau WY, Hsu C, et al. Radiofrequency ablation is superior to ethanol injection in early-stage hepatocellular carcinoma irrespective of tumor size. PLoS ONE. 2013;8:e80276.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Peng ZW, Liu FR, Ye S, et al. Radiofrequency ablation versus open hepatic resection for elderly patients (>65 years) with very early or early hepatocellular carcinoma. Cancer. 2013;119:3812–3820.

    Article  PubMed  Google Scholar 

  11. Geyik S, Akhan O, Abbasoglu O, et al. Radiofrequency ablation of unresectable hepatic tumors. Diagn Interv Radiol. 2006;12:195–200.

    PubMed  Google Scholar 

  12. Zhang YJ, Liang HH, Chen MS, et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: a prospective randomized trial. Radiology. 2007;244:599–607.

    Article  PubMed  Google Scholar 

  13. Cirocchi R, Trastulli S, Boselli C, et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev. 2012;6:CD006317.

    Google Scholar 

  14. Ruers T, Punt C, Van Coevorden F, et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004). Ann Oncol. 2012;23:2619–2626.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Garrean S, Hering J, Saied A, et al. Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature. Am J Surg. 2008;195:508–520.

    Article  PubMed  Google Scholar 

  16. Weng M, Zhang Y, Zhou D, et al. Radiofrequency ablation versus resection for colorectal cancer liver metastases: a meta-analysis. PLoS ONE. 2012;7:e45493.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zou YP, Li WM, Zheng F, et al. Intraoperative radiofrequency ablation combined with 125 iodine seed implantation for unresectable pancreatic cancer. World J Gastroenterol. 2010;16:5104–5110.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tang Z, Wu YL, Fang HQ, et al. [Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with ‘cool-tip needle’: report of 18 cases]. Zhonghua Yi Xue Za Zhi. 2008;88:391–394.

    PubMed  Google Scholar 

  19. Hadjicostas P, Malakounides N, Varianos C, et al. Radiofrequency ablation in pancreatic cancer. HPB (Oxf). 2006;8:61–64.

    Article  CAS  Google Scholar 

  20. Wu Y, Tang Z, Fang H, et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol. 2006;94:392–395.

    Article  PubMed  Google Scholar 

  21. Carrafiello G, Lagana D, Cotta E, et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Interv Radiol. 2010;33:835–839.

    Article  Google Scholar 

  22. Chiou YY, Hwang JI, Chou YH, et al. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci. 2005;21:304–309.

    Article  PubMed  Google Scholar 

  23. Fan WJ, Wu PH, Zhang L, et al. Radiofrequency ablation as a treatment for hilar cholangiocarcinoma. World J Gastroenterol. 2008;14:4540–4545.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Slakey DP. Radiofrequency ablation of recurrent cholangiocarcinoma. Am Surg. 2002;68:395–397.

    PubMed  Google Scholar 

  25. Rustagi T, Jamidar PA. Endoscopic treatment of malignant biliary strictures. Curr Gastroenterol Rep. 2015;17:426.

    PubMed  Google Scholar 

  26. Rustagi T, Jamidar PA. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig Dis Sci. 2014;59:2635–2641. doi:10.1007/s10620-014-3237-9.

    Article  PubMed  Google Scholar 

  27. Goldberg SN, Mallery S, Gazelle GS, et al. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc. 1999;50:392–401.

    Article  CAS  PubMed  Google Scholar 

  28. Kim HJ, Seo DW, Hassanuddin A, et al. EUS-guided radiofrequency ablation of the porcine pancreas. Gastrointest Endosc. 2012;76:1039–1043.

    Article  PubMed  Google Scholar 

  29. Gaidhane M, Smith I, Ellen K, et al. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract. 2012;2012:431451.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Silviu UB, Daniel P, Claudiu M, et al. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas: an experimental study with pathological correlation. Endosc Ultrasound. 2015;4:330–335.

    Article  PubMed  Google Scholar 

  31. Yoon WJ, Daglilar ES, Kamionek M, et al. Evaluation of radiofrequency ablation using the 1-Fr wire electrode in the porcine pancreas, liver, gallbladder, spleen, kidney, stomach, and lymph nodes: a pilot study. Dig Endosc. 2016;28:465–468.

    Article  Google Scholar 

  32. Hines-Peralta A, Hollander CY, Solazzo S, et al. Hybrid radiofrequency and cryoablation device: preliminary results in an animal model. J Vasc Interv Radiol. 2004;15:1111–1120.

    Article  PubMed  Google Scholar 

  33. Carrara S, Arcidiacono P, Albarello L, et al. Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas: a preliminary study. Endoscopy. 2008;40:321–326.

    Article  CAS  PubMed  Google Scholar 

  34. Petrone MC, Arcidiacono PG, Carrara S, et al. US-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study. Gastrointest Endosc. 2010;71:1294–1297.

    Article  PubMed  Google Scholar 

  35. Pai M, Habib N, Senturk H, et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg. 2015;7:52–59.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rossi S, Viera FT, Ghittoni G, et al. Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas. 2014;43:938–945.

    Article  PubMed  Google Scholar 

  37. Song TJ, Seo DW, Lakhtakia S, et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc. 2015;83:440–443.

    Article  PubMed  Google Scholar 

  38. Lakhtakia 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. 2015;83:234–239.

    Article  PubMed  Google Scholar 

  39. Arcidiacono PG, Carrara S, Reni M, et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc. 2012;76:1142–1151.

    Article  PubMed  Google Scholar 

  40. Date RS, McMahon RF, Siriwardena AK. Radiofrequency ablation of the pancreas. I: definition of optimal thermal kinetic parameters and the effect of simulated portal venous circulation in an ex vivo porcine model. JOP. 2005;6:581–587.

    PubMed  Google Scholar 

  41. Date RS, Siriwardena AK. Radiofrequency ablation of the pancreas. II: intra-operative ablation of non-resectable pancreatic cancer. A description of technique and initial outcome. JOP. 2005;6:588–592.

    PubMed  Google Scholar 

  42. den Brok MH, Sutmuller RP, van der Voort R, et al. In situ tumor ablation creates an antigen source for the generation of antitumor immunity. Cancer Res. 2004;64:4024–4029.

    Article  Google Scholar 

  43. Wissniowski TT, Hänsler J, Neureiter D, et al. Activation of tumor-specific T lymphocytes by radio-frequency ablation of the VX2 hepatoma in rabbits. Cancer Res. 2003;63:6496–6500.

    CAS  PubMed  Google Scholar 

  44. Cantore M, Girelli R, Mambrini A, et al. Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma. Br J Surg. 2012;99:1083–1088.

    Article  CAS  PubMed  Google Scholar 

  45. Frigerio I, Girelli R, Giardino A, et al. Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center. J Hepatobiliary Pancreat Sci. 2013;20:574–577.

    Article  PubMed  Google Scholar 

  46. Rustagi T, Gleeson FC, AbuDayyeh BK, Topazian MD, Levy MJ. Evaluation of effects of radiofrequency ablation of ex vivo liver using the 1-Fr wire electrode. J Clin Gastroenterol. 2017. doi:10.1007/s10620-017-4452-y.

  47. Hirota M, Kimura Y, Ishiko T, et al. Visualization of the heterogeneous internal structure of so-called “pancreatic necrosis” by magnetic resonance imaging in acute necrotizing pancreatitis. Pancreas. 2002;25:63–67.

    Article  PubMed  Google Scholar 

  48. Xiao B, Zhang XM. Magnetic resonance imaging for acute pancreatitis. World J Radiol. 2010;2:298–308.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Matsui Y, Nakagawa A, Kamiyama Y, et al. Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas. 2000;20:14–20.

    Article  CAS  PubMed  Google Scholar 

  50. Elias D, Baton O, Sideris L, Lasser P, Pocard M. Necrotizing pancreatitis after radifrequency destruction of pancreatic tumors. Eur J Surg Oncol. 2004;30:85–87.

    Article  CAS  PubMed  Google Scholar 

  51. Varshney S, Sewkani A, Sharma S, et al. Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety. JOP. 2006;7:74–78.

    PubMed  Google Scholar 

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Correspondence to Tarun Rustagi.

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Rustagi, T., Chhoda, A. Endoscopic Radiofrequency Ablation of the Pancreas. Dig Dis Sci 62, 843–850 (2017). https://doi.org/10.1007/s10620-017-4452-y

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