Role of endoscopic ultrasound in the treatment of pancreatic neuroendocrine tumors: Lights and shadows of endoscopic ultrasound-guided radiofrequency ablation

Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of pancreatic neoplasms that originate from the endocrine cells of the pancreas, whose prevalence and incidence are constantly increasing worldwide. Based on current knowledge of their natural history, pNETs can be divided into functioning pNET and nonfunctioning pNET tumors, characterized by hormone hypersecretion, which results distinct clinical presentations. Treatment options include observation, medical or surgical therapy, and the choice depends on various factors such as staging and grading of the pancreatic lesion and the presence of a specific hormonal syndrome. Surgical resection has long been considered the gold standard for treatment, with related risks of morbidity and mortality. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) plays a crucial role as minimally invasive procedure for loco-regional treatment of pNETs in selected patients, showing promising results in terms of clinical outcome. EUS-RFA causes a coagulative necrosis with minimal damage to surrounding tissue, allowing for local ablation. This review summarizes the most recent evidences on the use of EUS-RFA as local ablation therapy describing the main endoscopic steps and providing a critical overview of patient selection criteria, side effects, and long-term outcomes.