Background and aims: Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are precancerous cystic lesions. Surgery is advised for high-risk stigmata (HRS) or multiple worrisome features (WF) but entails substantial morbidity, and many resections reveal only low-grade dysplasia. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a minimally invasive alternative, yet long-term data are limited.
Methods: We retrospectively analyzed a prospectively maintained cohort of consecutive patients who underwent EUS-RFA for BD-IPMNs with WF/HRS at a tertiary referral center (2015-2024). Eligible patients were inoperable or declined surgery. Outcomes included technical success, adverse events (AEs), local control (resolution of WF/HRS with no cancer arising from the treated lesion), radiologic response, and pancreas-wide events.
Results: Fifty patients (62 procedures; 58 lesions) were treated. Mean follow-up was 4.1±2.8 years after RFA (9 years from IPMN diagnosis). Technical success was 100%. AEs occurred in 27% of procedures, mostly mild abdominal pain; post-procedural pancreatitis occurred in 3 patients, including one case necrotizing pancreatitis; there were no procedure-related deaths. Local control was achieved in 98% of lesions; 17% showed complete radiologic disappearance and 86% decreased in size. No treated lesion progressed to cancer. Pancreas-wide disease control was maintained in 80% of patients; four (8%) developed pancreatic cancer remote from the treated cyst. Smaller cyst size and fewer WF were associated with better outcomes.
Conclusion: EUS-RFA is feasible, safe, and provides durable local control of BD-IPMNs with WF/HRS in patients unsuitable for surgery or declining resection. These results support EUS-RFA as a promising therapeutic option in carefully selected patients. Larger prospective studies are needed to refine selection criteria and confirm long-term oncologic benefit.
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