Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging and minimally invasive modality that may offer a therapeuthic alternative to surgery in selected patients with pancreatic neuroendocrine tumors (pNETs). This study reports a single-center experience with EUS-RFA for pNETs ≤2 cm, with emphasis on its safety and efficacy.

A total of 62 patients with 65 histologically proven G1 pNETs underwent EUS-RFA and were included in this retrospective analysis. Surveillane was perfomed using EUS and/or contrast enhanced computed tomography (CT). Adverse events were classified according to the AGREE criteria.

Sixty two patients (25 males; mean age 53 years) with 65 lesions (mean lesion size 12.1mm; range 7-25) were treated with EUS-RFA (mean total ablation time for lesion  39.9±33s; range 5-168s; mean session number 1.52; range 1-5). The cohort comprised 57 non-functioning pNETs (88%) and 8 insulinomas (12%). All patients with insulinomas remained asymptomatic during follow-up. Overall, 78% of patients achieved complete regression, defined as no contrast enhancement in CT or/and EUS, while 22% demonstrated partial response (mean follow-up 18.7± 15.3 months; range 3-56 months). Regarding safety, most patients (88%) presented no adverse events. Three patients (5%) developed Grade I AEs, four (6%) Grade II AEs and one (1.5%) Grade IIIA AE.

EUS-RFA appears to be an effective and safe treatment option for small pNETs. Prospective studies with longer follow-up are warranted to better define long-term outcomes and recurrence rates.