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Cho et al. Mini-invasive Surg 2021;5:20 https://dx.doi.org/10.20517/2574-1225.2021.11 Page 7 of 8

mucinous cystic neoplasm, n = 1] underwent EUS-RFA. At the 12-month follow-up, 11 PCLs (65%) had
been resolved and one had decreased in diameter by > 50%. In this study, one patient with BD-IPMN
experienced jejunal perforation. Aspirating cystic fluid before RFA can avoid having to apply a
[20]
radiofrequency current into the liquid to ablate the cystic tumors. Oh et al. conducted a retrospective
study in 13 patients with microcystic serous cystic neoplasms (SCNs) of honeycomb appearance in whom
EUS-RFA was the primary treatment. In this study, radiologic partial response was identified in 8 patients
(61.5%), and 1 patient (7.7%) experienced mild abdominal pain. Although the data regarding EUS-RFA for
cystic tumors are currently limited, it is a technically feasible, potentially effective, and safe means of
managing PCLs.

Outcomes of EUS-RFA in pancreatic cancer
EUS-RFA has been used for treating patients with pancreatic cancer. Song et al. conducted a median of 1.3
[8]
sessions of EUS-RFA on 6 patients with unresectable pancreatic cancer. EUS-RFA was successful in all
patients, and 2 patients experienced mild abdominal pain without serious adverse events. In a recent study
[9]
by Scopelliti et al. , EUS-RFA combined with systemic chemotherapy was performed in 10 patients with
unresectable pancreatic cancer. After tumor ablation, an abdominal computed tomography 30 days post-
procedure revealed a delineated hypodense ablated area within the tumor in all patients. Although the role
of EUS-RFA on pancreatic cancer is still being investigated, RFA may induce a secondary anticancer
immune response by activating tumor-specific T lymphocytes and heat shock protein 70 expression [21,22] .
[8]
Thermal ablation could increase blood flow in the ablated tissues . EUS-RFA could affect post-procedural
tumor changes associated with a systemic antitumor immune response, enhancing the systemic
chemotherapy effect.

SUMMARY
The recent development of EUS devices has expanded the role of local treatment of EUS in pancreatic
tumors. EUS-RFA may be a definite treatment for benign pancreatic tumors. EUS-RFA for pancreatic
cancer could reduce tumor size, enhance the chemotherapeutic effect, and improve survival in cases of
advanced pancreatic cancer. Given the promising results of previous reports, EUS-RFA can potentially
change the clinical management of pancreatic neoplasms. Large-scale, prospective, randomized controlled
trials are required to verify the role of EUS-guided ablation in pancreatic neoplasms.

DECLARATIONS
Authors’ contributions
Conception and design: Seo DW
Analysis and interpretation of the data: Cho SH, Oh D
Drafting of the article: Cho SH, Oh D
Critical revision of the manuscript for important intellectual content: Seo DW
Supervision: Seo DW
Final approval of the article: Seo DW

Availability of data and materials
Not applicable

Financial support and sponsorship
None