Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor.

Radiofrequency ablation (RFA), a method of achieving tumor necrosis by cell protein denaturation that is induced by heating tissues to above 45°C, is applied in the treatment of several malignancies. Energy is provided by an RFA current generator, which is connected to an active electrode needle that is placed into the tumor under image guidance. The lesions created have variable diameters, depending on the intensity of the current used, the active tip length, and the treatment duration [1]. Recently a novel RFA needle (EUSRA RF Electrode; STARmed, Koyang, Korea) has been developed for use under endoscopic ultrasound (EUS) guidance [2]. It is an 18G water-cooled needle, with a long active tip of 5–30mm (●" Fig.1), which is connected to a radiofrequency generator (VIVA RF generator; STARmed). A 76-year-old man was referred for treatment of a pancreatic nodule. His laboratory results were within the normal ranges. An abdominal computed tomography (CT) scan showed a hypervascular 20-mm nodule in the pancreatic tail. EUSguided fine needle aspiration (FNA) revealed a pancreatic neuroendocrine tumor (pNET) with a Ki67 proliferative indexof >5%, consistent with a G2 grading (●" Fig.2). The patient refused to undergo surgical resection and we decided to treat the lesion by EUS-guided RFA. With the patient under general anesthetic, the nodule was ablated in a single session, with two passes of an exposed-tip needle (10-mm long) (●" Video 1). Indometacin 100mg was administered via suppositories. The patient remained asymptomatic, with normal serum pancreatic enzymes, and was discharged on the third day. A CT scan and contrast-enhanced EUS performed after 1 month confirmed complete radiological ablation (●" Fig.3). No complications were observed and to date the patient remains free of disease. The recommended standard of care of pNETs is surgical resection of functioning nodules, and of large or high grade nonfunctioning nodules (>2cm, G2–G3), with a burden of relevant costs and postoperative complications [3]. In this case EUS-guided RFA appeared feasible and