Endoscopic Ultrasound-Guided Radiofrequency Ablation for Pancreatic Metastases: Safety and Clinical Outcomes in a Single-Center Case Series

Background/Objectives: Pancreatic metastases are uncommon, and local treatment is reserved for selected patients with limited disease. Surgery remains the standard option when feasible, but may be inappropriate in patients with small, multifocal, anatomically challenging, or medically high-risk lesions. This study evaluated endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as an organ-preserving local treatment for pancreatic metastases. Methods: Consecutive adult patients undergoing EUS-RFA for histologically confirmed pancreatic metastases at a tertiary endoscopy center between February 2021 and December 2025 were included. All cases were discussed in a multidisciplinary setting. EUS-RFA was performed using a 19G internally cooled RFA needle under real-time EUS guidance. The primary endpoint was initial complete radiological response, defined as complete ablation on first follow-up imaging. Secondary endpoints included technical success, radiological response, repeat EUS-RFA, adverse events, follow-up, and survival. Results: Eleven patients were treated; the mean age was 72.4 ± 6.4 years, and 7/11 (63.6%) were women. Primary tumors included renal cell carcinoma in 7/11 (63.6%), breast cancer in 2/11 (18.2%), melanoma in 1/11 (9.1%), and colorectal cancer in 1/11 (9.1%). Median lesion size was 10.5 mm. Technical success was achieved in 11/11 patients (100%). Initial complete radiological response at first follow-up was observed in 10/11 patients (90.9%); the remaining patient achieved complete response after repeat EUS-RFA. Adverse events occurred in 3/11 patients (27.3%), all mild and conservatively managed. No bleeding, perforation, pancreatic duct stenosis, pancreatic collection, or procedure-related death occurred. Median follow-up was 338 days. Conclusions: EUS-RFA appears feasible and generally well tolerated in carefully selected patients with pancreatic metastases, particularly small, well-visualized lesions when surgery is not feasible or an organ-preserving strategy is preferred. Larger prospective multicenter studies are needed. Although formal subgroup comparisons were not possible in this small cohort, lesion size, anatomical location, and primary tumor biology are likely to influence technical difficulty, local response, and the need for staged or repeat treatment.