Impact of endoscopic ultrasound-guided radiofrequency ablation in managing pancreatic malignancy

Pancreatic malignancy is still the most lethal gastrointestinal malignancy. It has avery poor prognosis with low survival rate. Surgery is still the main treatmentoption for pancreatic malignancy. Most patients already have locally advancedand even late stage disease due to non-specific abdominal symptoms. Eventhough some cases are still suitable for surgical treatment, due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment forcontrolling the disease. Radiofrequency ablation (RFA) is a thermal therapy thathas been used as one of the standard treatments for liver malignancy. It can alsobe performed intraoperatively. There are several reports on percutaneous RFAtreatment for pancreatic malignancy using transabdominal ultrasound andguided by computed tomography scan. However, due to its anatomical locationand the risk of high radiation exposure, these methods seem to be very limited.Endoscopic ultrasound (EUS) has been widely used for pancreatic abnormalityevaluation due to its ability to detect more accurately, especially small pancreaticlesions, compared to other imaging modalities. By the EUS approach, it is easier toachieve good visualization of tumor ablation and necrosis as the echoendoscopeposition is closer to the tumor area. Based on studies and a recent meta-analysis,EUS-guided RFA is a promising treatment approach for most pancreaticmalignancy cases, but most studies only collected data from a small sample size.Larger studies are needed before clinical recommendations can be made.