Tringali A, Caiazzo A. Role of endoscopic ultrasound in the treatment of pancreatic neuroendocrine tumors: Lights and shadows of endoscopic ultrasound-guided radiofrequency ablation. World J Gastrointest Endosc 2026; 18(1): 113617 [PMID: 41607387 DOI: 10.4253/wjge.v18.i1.113617]
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02445547
Submitted on:
January 15, 2026, 09:27
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Reader Comments:
This minireview provides a timely and balanced synthesis of the evolving role of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) in the management of pancreatic neuroendocrine tumors (pNETs). The authors appropriately frame EUS-RFA as a promising yet still selective therapeutic option, and the “lights and shadows” construct is effective in highlighting both its clinical potential and its current limitations
A major strength of the article lies in its comprehensive collation of published clinical experience across functioning and non-functioning pNETs. The tabulated summaries are particularly valuable for readers seeking an overview of technical success, clinical response, and adverse event profiles. Importantly, the authors avoid overstating efficacy and consistently acknowledge the predominance of retrospective series, limited follow-up durations, and heterogeneity in response definitions—an intellectua rigour that strengthens the manuscript.
From a conceptual standpoint, the review highlights a key paradigm shift: EUS-RFA is no longer merely a salvage or palliative modality, but a potential intermediate option within the “grey zone” of small, low-grade pNETs, especially in patients unfit for surgery or those prioritizing minimally invasive approaches. This raises an important clinical question not fully resolved in current guidelines—whether EUS-RFA should eventually be positioned as a disease-modifying therapy rather than an alternative to surveillance.
The discussion on radiological response assessment underscores a critical unmet need in the field. The lack of standardized imaging endpoints, timing of follow-up, and correlation with long-term oncologic outcomes limits meaningful comparison across studies. Future consensus on response metrics—possibly integrating contrast-enhanced harmonic EUS, cross-sectional imaging, and biochemical markers—would significantly enhance interpretability and clinical adoption.
Finally, the article appropriately calls attention to procedural standardization and risk mitigation, particularly regarding pancreatitis prevention and proximity to the main pancreatic duct. These considerations will be central if EUS-RFA is to move beyond expert centers into broader clinical practice.
Overall, this review serves as a valuable reference for gastroenterologists, endosonographers, and multidisciplinary teams managing pNETs. It also clearly delineates the research priorities required before EUS-RFA can be fully integrated into evidence-based treatment algorithms.