Tu1410 FEASIBILITY, SAFETY, AND EFFICACY OF ENDOSCOPIC ULTRASOUND GUIDED RADIOFREQUENCY ABLATION (EUS-RFA) OF PANCREATIC DUCTAL ADENOCARCINOMA: A SINGLE CENTER US EXPERIENCE

Recent development and FDA approval of a novel monopolar RF catheter [Habib™ EUS RFA catheter, Emcision Ltd., London] have made the EUS guided RFA of pancreatic lesions feasible. Our study aimed to assess the feasibility and safety of EUS guided RFA for locally advanced unresectable and metastatic pancreatic ductal adenocarcinoma. The procedure involved advancing a 22 or 19-gauge FNA needle under EUS-Doppler guidance into the target lesion followed by placement of a 1 Fr Habib EUS RFA catheter through the needle after withdrawal of stylet. The FNA needle is then withdrawn maintaining position of the RFA probe inside the tumor to expose its active part. RFA energy was applied in 3-5 cycles each lasting 2 minutes at the setting of soft coagulation effect of 4 and power setting of 10 watts. A total of 10 patients of ages 59-66 (70% males) underwent 15 EUS guided RFA procedures. There were 2 Asian patients (20%) and 8 Caucasian patients (80%). Four patients (40%) had stage 3 and 6 patients had stage 4 cancer. Fourteen procedures (93.3%) were performed on an outpatient basis with 11 procedures (73.3%) performed under Propofol based sedation and 4 under general anesthesia. Median number of RFA applications was 4 (IQR 3-5). For 6 procedures (40%) a 22-gauge needle was used, and a 19-gauge needle was used for the other procedures. The locations of the target lesion were head of pancreas (n=3), genu (n=2), body of pancreas (n=3), and tail of pancreas (n=2). Prior to treatment, the average lesion size was 27 x 23 mm and this was reduced to 23 x 20 mm, but this was not statistically significant. Median procedure time was 30 minutes (IQR 23-33). Technical success was achieved in all patients. There were no major adverse events including any episode of pancreatitis or gastrointestinal bleeding. One patient developed more severe abdominal pain immediately after the procedure. Median length of follow up was 4.5 months (IQR 2-5). Two patients (20%) died during follow up. EUS guided RFA of pancreatic ductal adenocarcinoma is a minimally invasive, safe and effective modality. It has an important potential role as a targeted therapy for focal treatment of unresectable locally advanced pancreatic adenocarcinoma in poor surgical candidates.