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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2015; 7(4): 52-59
Published online Apr 27, 2015. doi: 10.4240/wjgs.v7.i4.52
Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors
Madhava Pai, Nagy Habib, Hakan Senturk, Sundeep Lakhtakia, Nageshwar Reddy, Vito R Cicinnati, Iyad Kaba, Susanne Beckebaum, Panagiotis Drymousis, Michel Kahaleh, William Brugge
Madhava Pai, Nagy Habib, Panagiotis Drymousis, HPB Unit, Hammersmith Hospital, Imperial College, W12 0HR London, United Kingdom
Nagy Habib, Emcision Limited, W12 0HS London, United Kingdom
Hakan Senturk, Department of Gastroenterology, Bezmi Alem University, 34093 Istanbul, Turkey
Sundeep Lakhtakia, Nageshwar Reddy, Asian Institute of Gastroenterology, Hyderabad 500082, India
Vito R Cicinnati, Iyad Kaba, Susanne Beckebaum, Department of Transplant Medicine, University Hospital Münster, 48149 Münster, Germany
Michel Kahaleh, Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY 10065, United States
William Brugge, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: Habib N developed the device concept and designed the study; Pai M, Senturk H, Reddy N, Kahaleh M and Brugge W materialized the design concept and designed the study; Senturk H, Lakhtakia S, Reddy N, Cicinnati VR, Kaba I and Beckebaum S contributed in patient screening, recruitment and procedures; Pai M, Senturk H, Lakhtakia S, Kaba I and Beckebaum S were responsible for the acquisition of data; Pai M and Habib N done the analysis and the interpretation of data; Pai M and Habib N drafted the manuscript; Habib N, Senturk H, Lakhtakia S, Reddy N, Cicinnati VR, Drymousis P, Kahaleh M and Brugge W did critical revisions of the manuscript and had input of important intellectual content; Pai M and Habib N did the statistical analysis; Pai M and Habib N were responsible for administrative, technical and material support; Habib N had the study supervision.
Conflict-of-interest: None of the other authors have a conflict of interest or a financial disclosure to declare.
Data sharing: Further technical data and device application details are available from Nagy Habib.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nagy Habib, Professor, Department of Surgery, HPB Unit, Hammersmith Hospital, Imperial College, Ducane Road, W12 0HR London, United Kingdom.
nagy.habib@imperial.ac.uk
Telephone: +44-020-33138574 Fax: +44-020-33133212
Received: June 19, 2014
Peer-review started: June 24, 2014
First decision: August 17, 2014
Revised: February 11, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: April 27, 2015
Processing time: 293 Days and 13 Hours
AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound (EUS)-radiofrequency ablation (RFA) in pancreatic neoplasms using a novel probe.
METHODS: This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation (RF) which was applied with an innovative monopolar RF probe (1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration (FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The Habib™ EUS-RFA is a 1 Fr wire (0.33 mm, 0.013”) with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and pancreas.
RESULTS: Eight patients [median age of 65 (range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cystic neoplasm (four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors (NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm (SD ± 17.9 mm) and 27.5 mm (SD ± 17.7 mm) respectively. The EUS-RFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm (SD ± 21.7 mm) vs mean post RF 20 mm (SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d.
CONCLUSION: EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The response ranged from complete resolution to a 50% reduction in size.
Core tip: This manuscript presents a pilot, safety feasibility study with the results of the first in humans endoscopic ultrasound (EUS) guided radiofrequency ablation (RFA) for cystic neoplasms and neuroendocrine tumors of the pancreas with a novel EUS-RFA catheter. EUS-RFA is feasible and well tolerated. EUS-RFA with this novel catheter provides endoscopic treatment option other than surgical resection for pancreatic lesions.
