Skip to main content
Top
Published in: Digestive Diseases and Sciences 4/2017

01-04-2017 | Review

Endoscopic Radiofrequency Ablation of the Pancreas

Authors: Tarun Rustagi, Ankit Chhoda

Published in: Digestive Diseases and Sciences | Issue 4/2017

Login to get access

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.
Literature
1.
go back to reference McGorisk T, Krishnan K, Keefer L, et al. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc. 2013;78:584–588.CrossRefPubMed McGorisk T, Krishnan K, Keefer L, et al. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc. 2013;78:584–588.CrossRefPubMed
2.
go back to reference 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. 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.
3.
go back to reference Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). Gastrointest Endosc. 2015;81:428–436.CrossRefPubMed Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). Gastrointest Endosc. 2015;81:428–436.CrossRefPubMed
5.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
6.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
7.
go back to reference Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.CrossRefPubMedPubMedCentral Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.CrossRefPubMedPubMedCentral
8.
go back to reference Wolf DS, Dunkin BJ, Ertan A. Endoscopic radiofrequency ablation of Barrett’s esophagus. Surg Technol Int. 2012;22:83–89.PubMed Wolf DS, Dunkin BJ, Ertan A. Endoscopic radiofrequency ablation of Barrett’s esophagus. Surg Technol Int. 2012;22:83–89.PubMed
9.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
10.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
11.
go back to reference Geyik S, Akhan O, Abbasoglu O, et al. Radiofrequency ablation of unresectable hepatic tumors. Diagn Interv Radiol. 2006;12:195–200.PubMed Geyik S, Akhan O, Abbasoglu O, et al. Radiofrequency ablation of unresectable hepatic tumors. Diagn Interv Radiol. 2006;12:195–200.PubMed
12.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
13.
go back to reference 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. 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.
14.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
15.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
16.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
17.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
18.
go back to reference 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 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
19.
go back to reference Hadjicostas P, Malakounides N, Varianos C, et al. Radiofrequency ablation in pancreatic cancer. HPB (Oxf). 2006;8:61–64.CrossRef Hadjicostas P, Malakounides N, Varianos C, et al. Radiofrequency ablation in pancreatic cancer. HPB (Oxf). 2006;8:61–64.CrossRef
20.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
21.
go back to reference Carrafiello G, Lagana D, Cotta E, et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Interv Radiol. 2010;33:835–839.CrossRef Carrafiello G, Lagana D, Cotta E, et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Interv Radiol. 2010;33:835–839.CrossRef
22.
go back to reference Chiou YY, Hwang JI, Chou YH, et al. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci. 2005;21:304–309.CrossRefPubMed Chiou YY, Hwang JI, Chou YH, et al. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci. 2005;21:304–309.CrossRefPubMed
23.
24.
go back to reference Slakey DP. Radiofrequency ablation of recurrent cholangiocarcinoma. Am Surg. 2002;68:395–397.PubMed Slakey DP. Radiofrequency ablation of recurrent cholangiocarcinoma. Am Surg. 2002;68:395–397.PubMed
25.
go back to reference Rustagi T, Jamidar PA. Endoscopic treatment of malignant biliary strictures. Curr Gastroenterol Rep. 2015;17:426.PubMed Rustagi T, Jamidar PA. Endoscopic treatment of malignant biliary strictures. Curr Gastroenterol Rep. 2015;17:426.PubMed
27.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
28.
go back to reference Kim HJ, Seo DW, Hassanuddin A, et al. EUS-guided radiofrequency ablation of the porcine pancreas. Gastrointest Endosc. 2012;76:1039–1043.CrossRefPubMed Kim HJ, Seo DW, Hassanuddin A, et al. EUS-guided radiofrequency ablation of the porcine pancreas. Gastrointest Endosc. 2012;76:1039–1043.CrossRefPubMed
29.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
30.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
31.
go back to reference 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.CrossRef 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.CrossRef
32.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
33.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
34.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
35.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
36.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
37.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
38.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
39.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
40.
go back to reference 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 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
41.
go back to reference 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 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
42.
go back to reference 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.CrossRef 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.CrossRef
43.
go back to reference 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.PubMed 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.PubMed
44.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
45.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
46.
go back to reference 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. 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.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
49.
go back to reference Matsui Y, Nakagawa A, Kamiyama Y, et al. Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas. 2000;20:14–20.CrossRefPubMed Matsui Y, Nakagawa A, Kamiyama Y, et al. Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas. 2000;20:14–20.CrossRefPubMed
50.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
51.
go back to reference Varshney S, Sewkani A, Sharma S, et al. Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety. JOP. 2006;7:74–78.PubMed Varshney S, Sewkani A, Sharma S, et al. Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety. JOP. 2006;7:74–78.PubMed
Metadata
Title
Endoscopic Radiofrequency Ablation of the Pancreas
Authors
Tarun Rustagi
Ankit Chhoda
Publication date
01-04-2017
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 4/2017
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-017-4452-y

Other articles of this Issue 4/2017

Digestive Diseases and Sciences 4/2017 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.