EUS-guided radiofrequency ablation of small pancreatic adenocarcinoma [Video]

EUS-guided radiofrequency ablation of small pancreatic adenocarcinoma: a new therapeutic option for patients unfit for surgery

We used a novel EUS-RFA system (STARmed, Seoul, Korea) consisting of a 19-gauge needle electrode (EUSRA, EUS-guided RFA electrode) covered with a sheath, except for the terminal 1 cm with a sharp conical tip for energy delivery, and an RF generator. Furthermore, this system features an internal cooling system that circulates chilled saline solution through the needle electrode during the RFA procedure to prevent charring of the surface of the electrode and to improve the accuracy of the ablation. The lesion was punctured at 2 different points, and 20W ablation power was delivered at both sites under direct EUS control. Ablation time was related to tissue impedance measured in real time by the RF generator. Bioimpedance reflects the property of a tissue to conduct electricity. An impedance rise is an indirect sign of cellular disruption, tissue charring, and hampering of electrical conduction. When a sudden rise in impedance was registered, power delivery was then stopped.