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. We searched 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 I 2 statistics. 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 a mean tumor size of 13.87 ± 0.82 cm and a mean duration follow-up of 13.36 months. Technical was assessed on per session basis, defined by EUS-guided access to PNETs along with the completion of the planned ablation procedure. Clinical success was defined as symptom resolution in functional lesions or complete ablation/disappearance or absence of imaging (cross-sectional or EUS) enhancement in nonfunctional lesions upon follow-up. The pooled technical success rate of EUS-RFA for PNETS was 97.6% (confidence interval 93.3%–99.2%; I 2 = 0%), and the pooled clinical success rate was 88.2% (76.3%–94.6%; I 2 = 74%). The pooled overall adverse event rate associated with EUS-RFA for PNETS was 19.6% (15.3%–24.9%; I 2 = 0%). The pooled rates of pancreatitis, bleeding, perforation, infection, and abdominal pain associated per procedure were as follows: 9.1% (6.2%–13.2%; I 2 = 0%); 4.0% (1.9%–8.2%; I 2 = 0%); 2.3% (1.0%–5.4%; I 2 = 0%); 2.3% (1.0%–5.4%; I 2 = 0%) and 8.8% (5.4%–14.1%; I 2 = 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 90.6% (68.1%–97.7%), whereas for studies with N <20 was 83.0% (69.3%–91.4%). On meta-analysis of EUS-RFA for PNETS, the overall technical success was 97.6%, the 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 pretreatment prophylactic measures to prevent this significant adverse event.
Bidani et al. (2026) studied this question.