양성 췌장 종양 환자에서의 내시경 초음파 유도하 고주파 치료의 유효성과 안전성 평가

Abstract

Background and Aims: Radiofrequency ablation (RFA) has been increasingly employed in both experimental and clinical settings for the management of pancreatic lesions. This study aimed to evaluate the feasibility, safety, and efficacy of endoscopic ultrasound (EUS)-guided RFA in the management of benign solid pancreatic tumors. Methods: In a single-center, prospective study, 10 patients with benign solid pancreatic tumors underwent EUS-RFA using an 18-gauge or 19-gauge endoscopic RFA electrode. After inserting the RFA electrode into the mass, the radiofrequency generator was activated under real-time visualization to deliver 50 W of ablation power for 10 seconds. Depending on the tumor size, the procedure was repeated to adequately ablatethe tumor. Complete ablation was defined by the disappearance of enhancing tissue at the tumor site on the contrast-enhanced imaging studies. Results: In 10 patients, 16 sessions of EUS-RFA were successfully performed. The patients underwent a median of 1 (range, 1–3) RFA sessions. There were 7 cases of nonfunctioning neuroendocrine tumors, 1 case of an insulinoma, and 2 cases of solid pseudopapillary tumors; the median largest diameter of the tumors was 20 mm (range, 8–28 mm). The anatomical locations of the pancreatic tumors were as follows: head (n=4), body (n=5), and tail (n=1). During the clinical and imaging follow-ups (median 15 months, range 10–32 months), the postprocedure imaging showed complete ablation in 7 patients. The median EUS diameter of the tumors changed from 20 mm (IQR 15–24 mm) at the baseline to 6.5 mm (IQR 3.7–11.3) at the end of the follow-up. The patient with a symptomatic pancreatic insulinoma had symptom relief with biochemical improvement after treatment. In the 16 total ablation procedures, the procedure-related adverse events included one patient with abdominal pain (6.2%) and one with pancreatitis (6.2%). Conclusions: EUS-RFA may be a safe and potentially effective treatment option in selected patients with benign solid pancreatic tumors. Multiple sessions may be required if there is a remnant or recurrent mass, and procedure-related adverse events must be cautiously monitored.