Endoscopic Ultrasound-Guided Radiofrequency Ablation in the Management of Pancreatic Tumors: A Comprehensive Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Radiofrequency ablation (RFA) is a proven therapy for solid organ tumors. Endoscopic ultrasound-guided RFA (EUS-RFA) is a less invasive, emerging technique that may serve as an alternative to surgical resection for unresectable pancreatic tumors (UPT). However, its efficacy, safety, and clinical outcomes in tumor subgroups remain unclear. This systematic review and meta-analysis evaluate the efficacy, clinical, and technical success (TS) of EUS-RFA for UPT. METHODS: A comprehensive search of PubMed, Web of Science, Embase, Cochrane, and Clinicaltrials.gov (as of April 2025) identified studies on EUS-RFA and pancreatic tumors. Primary outcomes were TS, defined as probe placement and ablation regardless of outcome, and clinical success (CS), defined as symptomatic improvement or tumor size reduction with necrosis. Secondary outcomes included adverse events and efficacy for tumor subtypes. A pooled analysis using random-effect modeling was performed using the metafor R package. RESULTS: Seventeen studies involving 168 patients (52.38% female) and 182 tumors were included. Tumors included pancreatic neuroendocrine tumors (106, 58.24%), pancreatic ductal adenocarcinomas (49, 26.92%), and others. Tumors were located primarily in the body, neck, or tail (54.02%). Average ablation sessions per patient were 1.1. Pooled TS and CS rates were 89% and 84%, respectively. Nonfunctional neuroendocrine tumors and mixed type showed the highest CS rate (91%). The most common adverse event included abdominal pain (6.5%) and hyperamylasemia (3.6%). CONCLUSION: EUS-RFA is a promising, safe modality for managing UPT, with high TS (89%) and CS (84%) rates. Larger clinical trials are needed to confirm safety, outcomes, and survival benefits for pancreatic cancer subtypes.