Pancreatic well-differentiated non-metastatic neuroendocrine tumors (PanNET) are rare neoplasms and often detected incidentally. Parenchyma-sparing surgery may be considered as first-line therapeutic approach; however, morbidity and the potential survival benefit must be carefully weighed. EUS-guided Radio Frequency Ablation (EUS-RFA) is a promising organ preserving endoscopic technique that can be performed in an outpatient setting and has the potential to serve as an alternative to surgery. We aimed to evaluate the safety and efficacy of pancreatic EUS-RFA.

We retrospectively reviewed all consecutive patients with solid pancreatic neoplasms who were scheduled to undergo EUS-RFA between 2020 and 2023 at a single tertiary center. Indications, procedural characteristics, adverse events and clinical outcomes were recorded. Safety outcomes were analyzed for all included patients. Clinical outcomes were assessed in all patients with somatostatin receptor-positive PanNETs, who completed one year of follow-up with both EUS/MRI and ⁶⁸Ga-Dotatate PET-CT. Serious adverse events were defined as those classified as AGREE grade ≥ 3 (requiring surgical, endoscopic or radiological intervention). Radiological response was evaluated by MRI and categorized as complete (no residual lesion), partial (> 75% volume reduction) or no response (< 75% reduction) at 9 months of follow-up. Nuclear imaging complete response rate was defined as the absence of ⁶⁸Ga-Dotatate uptake at 1-year of follow-up.

A total of 23 patients were scheduled for EUS-RFA; in 2 cases the procedure was deemed not feasible due to the lesion’s close proximity (< 1 mm) to the pancreatic duct or a vessel. Adverse events consisted of one (5%) intraprocedural bleed that resolved spontaneously, and mild pancreatitis occurred in 5 patients (24%). No serious adverse events occurred. Sixteen patients had SSTR-positive PanNETs, of whom 14 completed full follow-up. Their median age was 67 years (IQR 64-77), and 9 patients (64%) were male. The median tumor diameter was 15 mm (IQR 11-18). Patients underwent a median of one RFA procedure (IQR 1-1) with a median of 3 ablations (IQR 3-4) per session. Radiological response was complete in 86% (12/14), partial in 7% (1/14) and absent in 7% (1/14). Patients with incomplete radiological response had PanNET located in uncinate process. A total of 8 patients (57%) demonstrated complete response on nuclear imaging.

Pancreatic EUS-RFA demonstrated an acceptable safety profile. More than 8 out of 10 patients with SSTR-positive PanNETs achieved complete radiological response, while almost 6 out of 10 patients achieved complete response on nuclear imaging following a single EUS-RFA session. In selected patients, EUS-RFA represent a feasible therapeutic alternative to pancreatic surgery.