Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation (
EUS
‐
RFA
) for Pancreatic Neoplasms: Results From an International Survey
Andrea Lisotti, Matteo Tacelli, Stefano Francesco Crinò, Graziella Masciangelo, Pietro Fusaroli, Marc Barthet, Nirav Thosani, Maria Cristina Conti Bellocchi, Sarah Leblanc, Tawfik Khoury, Paolo Giorgio Arcidiacono, Antonio Facciorusso, Fabrice Caillol, Marc Giovannini, Lorenzo Fuccio, Jayanta Samanta, Anthony Y. B. Teoh, Takeshi Ogura, Roald Flesland Havre, Somashekar G. Krishna, Bojan Kovacevic, Vinay Dhir, Peter Vilmann, Sundeep Lakhtakia, Bertrand Napoléon, Khanh Do‐Cong Pham ABSTRACT
Background and Aims
Endoscopic ultrasound‐guided radiofrequency ablation (EUS‐RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real‐world practice among international users.
Methods
A cross‐sectional 70‐item survey was conducted. Results are presented descriptively (numbers, percentages).
Results
Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS‐RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS‐RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located ≤ 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post‐procedural management and follow‐up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post‐RFA pancreatitis.
Conclusions
Despite the global expansion of EUS‐RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high‐quality evidence.