EUS-Guided Crio-thermal Ablation of Pancreatic Neoplasia

Pancreatic cancer still presents a dismal prognosis despite recent great efforts in chemoradiotherapy regimens. The development of different devices applied to endoscopic ultrasound (EUS), on the basis of EUS-guided fine needle aspiration (EUS FNA) technique principle, has led this approach to become also an interventional procedure. EUS-guided direct tumor thermal ablation represents a minimally invasive potential antitumor therapeutic alternative to radiological and surgical treatments for patients not amenable to surgical treatments. The EUS-guided approach is well suited to pancreatic cancer because of its superior anatomical access compared with other imaging modalities. Currently, a variety of probes specifically designed for EUS thermal ablation for treatment of pancreatic cancer are available with the aim of providing better local disease control and reduce metastatic tumor spreading, including the Hybrid Therm Probe (ERBE, Elektromedizin GmbH, Tubingen, Germany) that has the peculiar property to combine the bipolar radiofrequency ablation and cryoablation technologies. EUS-guided cryothermal ablation using the Hybrid Therm Probe showed to be feasible and safe for the treatment of patients with unresectable locally advanced pancreatic adenocarcinoma. This chapter provides a description of the EUS-guided ablation technique using the Hybrid Therm Probe and its development and clinical application. The long-term efficacy of EUS-guided cryothermal ablation is under investigation.