Is EUS-guided Ablation Feasible To Treat Nonfunctioning Pancreatic Neuroendocrine Tumors Smaller Than 2 cm?

Although small (<2 cm), nonfunctioning pancreatic neuroendocrine tumors (PNETs) are typically followed, there are instances, such as patient anxiety, that prompt resection. Endoscopic ultrasound-guided ethanol ablation (EUS-EA) has been used as an alternative modality to surgery to treat PNETs. This propensity score-matching study aimed to compare the safety and long-term outcomes of EUS-EA with those of surgery for the management of nonfunctioning, small PNETs. 

The study included 97 patients who underwent EUS-EA and 188 who underwent surgery at a single medical center. Propensity score matching resulted in 89 matched pairs. Early (within 14 days) major complications were significantly lower in patients who underwent EUS-EA versus surgery (0% vs 11.2%; P=.003). There was no statistical difference in late (after 14 days) complications (3.4% vs 10.1%; P=.07). Both treatment modalities had similar 10-year overall and disease-specific survival rates. The average number of days spent in the hospital was significantly less in the EUS-EA group (4 days vs 14.1 days; P<.001), and endocrine pancreatic insufficiency occurred less often after EUS-EA (33.3% vs 48.6%; P=.121). 

It is important to note that in the EUS-EA group, only 64.9% of patients showed complete ablation (defined as no suspicious viable tumor at the time of radiologic evaluation), and 46% of those showed local recurrence after complete ablation.