P3760 - Case Series: Application of Radiofrequency Ablation in Various Pancreatic Neoplastic Lesions

Award: Presidential Poster Award

Varshita Goduguchinta, DO¹, Ahamed Khalyfa, DO², Navkiran Randhawa, DO³, Rahil Desai, DO⁴, Mahnoor Inamullah, MD⁵, Kamran Ayub, MD^6
1Franciscan Health Olympia Fields, Chicago, IL; ²University of Iowa, Iowa City, IA; ³Augusta University, Medical College of Georgia, Dyer, IN; ⁴Franciscan Health Olympia Fields, Westlake, OH; ⁵Southwest Gastroenterology, a Division of GI Partners of Illinois, Oak Lawn, IL; ⁶Silver Cross Hospital, New Lenox, IL

Introduction: Treatment of pancreatic neoplasms is inherently dependent on clinical staging of disease and resectability of the tumor. However, surgical resection is not an option in some patients with comorbidities or other high risk features. Our aim was to study the efficacy and safety of endoscopic radiofrequency ablation (RFA) as an alternative to surgery as it was not an option in these patients. Our series includes patients with neuroendocrine tumors, adenocarcinoma and intraductal papillary mucinous neoplasm with malignant nodule.

Case Description/Methods: A 75-year-old male with a medical history of coronary artery disease, hypertension, hyperlipidemia, and iron deficiency anemia presented with abdominal pain. CT Abdomen/Pelvis was obtained and highlighted a subtle distal pancreatic mass. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) was later performed on the hypoechoic nodule measuring 15.6 x 12 mm in the pancreatic tail. Pathology identified the mass as a neuroendocrine tumor (NET). Surgery was felt to be extremely high-risk and the patient refused this option. An EUS-guided radiofrequency ablation (RFA) was performed using a 19-gauge RFA needle with 10 watts energy, with 6 applications (30, 21, 35, 22, 29, and 34 seconds). Follow up CT 8 weeks later demonstrated subtle disease at the pancreatic tail. Repeat EUS-FNA was performed and showed that the pancreatic mass had shrunk, now 11.3 mm x 7.2 mm. Repeat EUS-RFA was performed with 4 applications (15, 18, 23, and 26 seconds, respectively) using 10 watts energy. Follow up EUS 4 months later demonstrated the pancreatic NET had disappeared completely, now replaced by scar tissue. One year later, patient continues to do well without any signs of residual disease.



RFA was applied for 3 other patients with pancreatic neoplasias (NET, adenocarcinoma, and IPMN), with good to excellent response. Although NET had the best response to RFA, the other neoplasms responded well to RFA as demonstrated by reduction of initial tumor size (Table 1). One patient had pancreatitis and was hospitalized for 3 days, a second patient had abdominal pain for 2 days after the procedure. No other complications were encountered.

Discussion: With our case series, we show that EUS-RFA of pancreatic neoplasia is a viable option in selected patients who are not candidates for pancreatic surgery.



Disclosures:


Varshita Goduguchinta, DO¹, Ahamed Khalyfa, DO², Navkiran Randhawa, DO³, Rahil Desai, DO⁴, Mahnoor Inamullah, MD⁵, Kamran Ayub, MD⁶. P3760 - Case Series: Application of Radiofrequency Ablation in Various Pancreatic Neoplastic Lesions, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.