Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.163
Peer-review started: September 23, 2022
First decision: October 5, 2022
Revised: October 21, 2022
Accepted: January 3, 2023
Article in press: January 3, 2023
Published online: February 27, 2023
Processing time: 156 Days and 19.4 Hours
Pancreatic malignancy is still the most lethal gastrointestinal malignancy. It has a very poor prognosis with low survival rate. Surgery is still the main treatment option for pancreatic malignancy. Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms. Even though some cases are still suitable for surgical treatment, due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease. Radiofrequency ablation (RFA) is a thermal therapy that has been used as one of the standard treatments for liver malignancy. It can also be performed intraoperatively. There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan. However, due to its anatomical location and the risk of high radiation exposure, these methods seem to be very limited. Endoscopic ultrasound (EUS) has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately, especially small pancreatic lesions, compared to other imaging modalities. By the EUS approach, it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area. Based on studies and a recent meta-analysis, EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases, but most studies only collected data from a small sample size. Larger studies are needed before clinical recommendations can be made.
Core Tip: Pancreatic cancer is still the most lethal gastrointestinal malignancy. Most patients are diagnosed at the late stage of the disease. Surgery is still the definitive treatment for managing pancreatic cancer. However, skill, experience, and expertise are required of the surgeon due to its high risk of complications. Recently, endoscopic ultrasound has been used for managing pancreatic cancer. Studies have shown its practicability, efficacy, and benefit in combination with standard chemotherapy. It would need larger studies before it can be recommended as standard management in clinical practice.