P2745 - Efficacy and Safety of EUS-RFA in Pancreatic Neuroendocrine Tumors: A Systematic Review and Meta-Analysis

Vishali Moond, MD¹, Khyati Bidani, MD¹, Jiteshwar S. Pannu, MD², Prateek Harne, MD³, Sruthi Subramanian, MD³, Babu Mohan, MD⁴, Nirav Thosani, MD^3
1Saint Peter's University Hospital, New Brunswick, NJ; ²University of Oklahoma Health Sciences Center, Oklahoma City, OK; ³McGovern Medical School at UTHealth, Houston, TX; ⁴Orlando Gastroenterology PA, Orlando, FL

Introduction: EUS-guided radiofrequency ablation (EUS-RFA) has gained recognition in the last decade as a preferred alternative method for pancreatic neuroendocrine tumors (PNETS) where surgical resection is contraindicated. However, clinical outcomes of EUS-RFA for PNETS have not been well studied due to variability in procedure techniques and lack of data from good quality studies.In this meta-analysis, we aim to study the pooled clinical outcomes of EUS-RFA in patients with PNETS.

Methods: We conducted a search of multiple electronic databases and conference proceedings from inception through Jan 2024. The clinical outcomes studied were pooled technical success, clinical success and adverse events. We also performed a subgroup analysis based on the sample size of the studies. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I2 statistics.

Results: We analyzed 11 studies which included 7 prospective and 4 retrospective studies involving 345 patients (55.3% females with a mean age of 58.73 +/- 3.01 years) having mean tumor size of 13.87 +/- 0.82 cm and a mean duration follow-up of 13.36 months.



The pooled technical success rate of EUS-RFA for PNETS was 97.6% (CI 93.3 - 99.2%; I2 = 0%) and the pooled clinical success rate was 88.2% (76.3 - 94.6%; I2 = 74%). The pooled overall adverse event rate associated with EUS-RFA for PNETS was 19.6% (15.3 - 24.9%; I2 = 0%). The pooled rates of pancreatitis, bleeding, perforation, infection, and abdominal pain associated per procedure were as follows: 9.1% (6.2 - 13.2%; I2 = 0%); 4.0% (1.9 - 8.2%; I2 = 0%); 2.3% (1.0 - 5.4%; I2 = 0%); 2.3% (1.0 - 5.4%; I2 = 0%) and 8.8% (5.4 - 14.1%; I2 = 0%), respectively. There were no reported deaths with EUS-RFA.



Due to the presence of small sample-size studies, subgroup analysis based on patient sample size of number (N) >20 and (N) < 20 was performed. The pooled clinical success rate for studies with N >20 was 90.6% (68.1 - 97.7%), whereas with N< 20 was 83.0% (69.3 - 91.4%).

Discussion: On meta-analysis of EUS-RFA for PNETS, the overall technical success was 97.6%, clinical success rate was 88.2% and the overall adverse events was 19.6%. A key finding of this study was the pooled pancreatitis rate of 9.1%. Future studies are warranted to study methods aimed at pre-treatment prophylactic measures to prevent this significant adverse event.



Disclosures:


Vishali Moond, MD¹, Khyati Bidani, MD¹, Jiteshwar S. Pannu, MD², Prateek Harne, MD³, Sruthi Subramanian, MD³, Babu Mohan, MD⁴, Nirav Thosani, MD³. P2745 - Efficacy and Safety of EUS-RFA in Pancreatic Neuroendocrine Tumors: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.