How to do EUS-guided Ablation of Pancreatic Neurendocrine Tumors

Pancreatic neuroendocrine tumors (pNETs) have shown a dramatic increase in terms of incidence and prevalence, especially since the widespread use of imaging studies and their better resolution. The factors to be taken into account when deciding the management of the patient with pNET are either patient related or pNET related, which are also strictly linked to the known risk of progression. The two main techniques under evaluation for EUS-guided ablation of p-NETs are radiofrequency ablation (RFA) and ethanol injection. RFA works at high temperatures, inducing thermally irreversible cellular damage on target tissues, with eventual cellular apoptosis and coagulative necrosis. Technical variables reported in different case series and case reports vary widely, and include the needle type and caliber, volume injected, concentration of alcohol, and techniques to minimize the risk of pancreatitis.