Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation ( <scp>EUS</scp> ‐ <scp>RFA</scp> ) for Pancreatic Neoplasms: Results From an International Survey

BACKGROUND AND AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real-world practice among international users. METHODS: A cross-sectional 70-item survey was conducted. Results are presented descriptively (numbers, percentages). RESULTS: Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS-RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS-RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located ≤ 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post-procedural management and follow-up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post-RFA pancreatitis. CONCLUSIONS: Despite the global expansion of EUS-RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high-quality evidence.

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Journal
Digestive Endoscopy
Published
2026-06-29
DOI
https://doi.org/10.1111/den.70212
Primary Topic
Neuroendocrine Tumor Research Advances
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article
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article

Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation ( EUS ‐ RFA ) for Pancreatic Neoplasms: Results From an International Survey

Somashekar G. Krishna, Stefano Francesco Crinò, Antonio Facciorusso, Fabrice Caillol et al.
Digestive Endoscopy
Neuroendocrine Tumor Research Advances
article

Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation ( EUS ‐ RFA ) for Pancreatic Neoplasms: Results From an International Survey

Somashekar G. Krishna, Stefano Francesco Crinò, Antonio Facciorusso, Fabrice Caillol, Maria Cristina Conti Bellocchi, Graziella Masciangelo, Khanh Do-Cong Pham, Tawfik Khoury, M Barthet, Pietro Fusaroli, P Vilmann, Roald Flesland Havre, Andrea Lisotti, Takeshi Ogura, Bojan Kovacevic, Marc Giovannini, A Y B Teoh, Nirav Thosani, Vinay Dhir, J Samanta, S Lakhtakia, S Leblanc, P Arcidiacono, B Napoleon, M Tacelli, Lorenzo Fuccio
article en

Abstract

BACKGROUND AND AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real-world practice among international users. METHODS: A cross-sectional 70-item survey was conducted. Results are presented descriptively (numbers, percentages). RESULTS: Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS-RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS-RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located ≤ 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post-procedural management and follow-up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post-RFA pancreatitis. CONCLUSIONS: Despite the global expansion of EUS-RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high-quality evidence.

Digestive EndoscopyVol. 38(7)
University of Verona (IT), Bar-Ilan University (IL), University of Salento (IT), Vita-Salute San Raffaele University (IT), Chinese University of Hong Kong (HK), Aix-Marseille Université (FR), Western Galilee Hospital (IL), Haukeland University Hospital (NO), Gentofte Hospital (DK), The Ohio State University Wexner Medical Center (US), Assistance Publique Hôpitaux de Marseille (FR), Hong Kong Sanatorium and Hospital (HK), Institut de Recherche contre les Cancers de l’Appareil Digestif (FR), Hôpital Nord (FR), Azienda USL di Bologna (IT), Hôpital Privé Jean Mermo (FR), Asian Institute of Gastroenterology (IN), Institut Paoli-Calmettes (FR), S.L. Raheja Hospital (IN), The University of Texas Health Science Center (US), University of Bergen (NO), Post Graduate Institute of Medical Education and Research (IN), Osaka University of Pharmaceutical Sciences (JP), University of Bologna (IT)
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Neuroendocrine Tumor Research Advances
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