The authors present a case of a  61-year-old male with alcohol-related cirrhosis, Child A, and large esophageal varices. Laboratory tests revealed thrombocytopenia (28,000/µL), prolonged prothrombin time (19.1 seconds), and fibrinogen of 99 mg/dL. Surveillance contrast-enhanced CT identified a 17 mm lesion in the pancreatic tail showing arterial contrast uptake. EUS-guided biopsy revealed a grade 1 pancreatic neuroendocrine tumor (pNET). Given the high surgical risk, a multidisciplinary team proposed EUS-guided radiofrequency ablation (RFA). During the procedure, after precise positioning of a 19G needle within the target lesion, 3 overlapping ablation applications were performed. Immediate intra-procedural imaging showed complete loss of contrast enhancement. 

EUS-RFA is an effective minimally invasive option for pNETs, mainly in high-risk patients.