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RADIOCYST - PHASE II MULTICENTRE SAFETY AND EFFICACY STUDY OF ENDOSCOPIC ULTRASOUND GUIDED RADIOFREQUENCY ABLATION OF CYSTIC TUMOURS OF THE PANCREAS

Alexander Ney 1, Peter LZ Labib 1, Matthew Huggett 2, Andrew Metz 3, Lyn Alexandra Smith 4, Norman R. Williams 1, Stephen P Pereira 1

Affiliations

1 University College London, London, United Kingdom

2 St James University Hospital, Leeds, United Kingdom

3 Royal Melbourne Hospital, Melbourne, Australia

4 Glasgow Royal Infirmary, Glasgow, United Kingdom

Summary

AI Generated

EUS-guided radiofrequency ablation of low-risk pancreatic mucinous cysts in 55 patients showed variable size reduction (ranging from minimal to complete resolution) with mostly mild adverse events and one serious perforation.

55 of 68 patients with low-risk branch-duct IPMN or mucinous cystadenomas (0.7-4cm) completed EUS-RFA, with 12 excluded due to anatomical concerns and 18 requiring a second ablation.
At one-year follow-up imaging, 18 patients showed 80-100% cyst size reduction, 5 showed 50-79% reduction, 4 showed 20-49% reduction, 18 showed less than 20% reduction, and one patient experienced cyst doubling.
One patient experienced scope-induced small bowel perforation (Clavien-Dindo grade 3); other adverse events were mild and included transient abdominal pain, bloating, sore throat, and nausea, plus one self-limiting seizure in a patient with epilepsy.
The authors conclude EUS-RFA was well tolerated and relatively safe, offering a potential alternative to lifelong surveillance for low-risk pancreatic cysts.

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Abstract

Introduction

Mucinous cysts of the pancreas are known precursors of pancreatic ductal adenocarcinoma. International guidelines for management and surveillance of pancreatic cysts advise surgical resection of high-risk lesions - mucinous cystic neoplasms (MCNs) and main duct intraductal papillary neoplasms (IPMNs), especially in those with worrisome clinicopathological stigmata. For low-risk cysts, lifelong radiographic surveillance is the standard approach, which can be psychologically distressing for patients and burdensome for healthcare systems. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) of high-risk cystic lesions of the pancreas is increasingly being used as a minimally invasive alternative in patients who are unfit for or who decline surgery (1). We assessed the safety and efficacy of EUS-guided RFA in the management of low-risk cystic lesions of the pancreas.

Aims & Methods

68 patients (29M, 39F; mean age 63, range 33-82 years) with low-risk mucinous cystic neoplasms of the pancreas (branch-duct IPMN/mucinous cystadenomas, 0.7-4cm in size) were recruited for treatment by EUS-RFA. The primary endpoint was change in size of the pancreatic cyst on cross-sectional imaging (MRI) at one year after treatment (efficacy). Secondary endpoints included progression following treatment, procedure related morbidity and local complication rate (safety).

Results

68 patients were recruited of whom 55 completed RFA ablation of their cyst. Anatomical concerns (i.e., blood vessel, main duct proximity) precluded RFA in 12 patients. 18/55 patients (33%) underwent a second ablation. Follow up imaging data were available for 46 (84%) patients and showed a <20% reduction in cyst size in 18 patients, 20-49% in 4 patients, 50-79% in 5 and 80-100% size reduction in 18 patients. For one patient, doubling in cyst size was recorded at the 12-month follow-up. Excluding one case of scope-induced small bowel perforation (Clavien-Dindo; ClvD grade 3), other adverse events were mild (ClvD 0-2) and expected (transient abdominal pain, bloating, sore throat, nausea/vomiting). One patient experienced a self-limiting, post procedure grand mal seizure on a background of epilepsy.

Conclusion

EUS-RFA was well tolerated in most cases. Our data indicate that the procedure is relatively safe. The response ranged from a <20% reduction in size to complete cyst resolution.

References

1. Papaefthymiou A, Johnson GJ, Maida M, Gkolfakis P, Ramai D, Facciorusso A, Arvanitakis M, Ney A, Fusai GK, Saftoiu A, Tabacelia D, Phillpotts S, Chapman MH, Webster GJ, Pereira SP. Performance and safety of EUS-ablation techniques for pancreatic cystic lesions: a systematic review and meta-analysis. Cancers 2023 [in press].

Disclosure

No conflict of interest

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Panel discussion: How to make and not miss the diagnosis: Coeliac disease across the spectrum

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Panel discussion: How to make and not miss the diagnosis: Coeliac disease across the spectrum

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition Primary Care Small Intestine & Nutrition

Session

PGT Opening: How to make and not miss the diagnosis - Coeliac disease across the spectrum

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Presentation

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How do we monitor this patient?

Virginia Solitano 1

Affiliations

1 IRCCS Ospedale San Raffaele, Milan, Italy

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

IBD

Session

Monitoring of disease activity in IBD

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Presentation

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Guiding the care of hypertriglyceridemia-induced acute pancreatitis: Multidisciplinary care and the role of new therapies through apoC-III inhibition (Sobi (Swedish Orphan Biovitrum)) (Complete Session)

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Guiding the care of hypertriglyceridemia-induced acute pancreatitis: Multidisciplinary care and the role of new therapies through apoC-III inhibition (Sobi (Swedish Orphan Biovitrum)) (Complete Session)

Vinciane Rebours 1, Gabriele Capurso 2, Clara Viñals 3

Affiliations

1 Hopital Beaujon, Clichy, France

2 San Raffaele Scientific Institute Irccs, Rome, Italy

3 Clínic Barcelona, Barcelona, Spain

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Abstract

Publisher

Sobi

Event

UEG Week Barcelona 2026

Session

Guiding the care of hypertriglyceridemia-induced acute pancreatitis: Multidisciplinary care and the role of new therapies through apoC-III inhibition (Sobi (Swedish Orphan Biovitrum))

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Presentation

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CLINICOPATHOLOGICAL CHARACTERISTICS AND LONG-TERM FOLLOW-UP PROGNOSIS OF PRIMARY ESD IN ECURA C-2 EARLY GASTRIC CANCER PATIENTS

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CLINICOPATHOLOGICAL CHARACTERISTICS AND LONG-TERM FOLLOW-UP PROGNOSIS OF PRIMARY ESD IN ECURA C-2 EARLY GASTRIC CANCER PATIENTS

Wei Wu 1, Jing2 Zhang 1

Affiliations

1 Peking University Third Hospital, Beijing, China

Summary

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Abstract

Introduction

Early gastric cancer (EGC), defined as carcinoma confined to the mucosa or submucosa irrespective of lymph node metastasis, accounted for over 968,000 new cases and 660,000 deaths globally in 2022, ranking fifth in both incidence and mortality worldwide. Endoscopic submucosal dissection (ESD) has emerged as the standard minimally invasive treatment for EGC, demonstrating both safety and high curability. Patients meeting absolute or expanded indications for ESD achieve 5-year overall survival rates exceeding 90%. The 2021 JGCA guidelines (6th edition) introduced the endoscopic curability (eCura) categories to assess post-ESD curability, which guides subsequent management decisions.
For a part of eCura-C-2 patients, don not receive additional surgery may be acceptable. In this study, we aim to analysis the clinicopathological features and long-term prognosis of different lymph node metastasis risk categories.

Aims & Methods

Background and aims: Endoscopic submucosal dissection(ESD) is the standard treatment for early gastric cancer(EGC) meeting absolute indications, with post-ESD management guided by the eCura(endoscopic curability) categories. This study focused on eCura C-2 patients—those at high risk of lymph node metastasis(LNM)—and compared outcomes between surgical intervention and conservative management. We aimed to evaluate the clinical utility of the eCura scoring system in therapeutic decision-making for this population.
Method: This retrospective study included 103 eCura C-2 EGC patients treated with initial ESD at Peking University Third Hospital(2010–2023). Clinicopathological features were compared across LNM risk strata. Primary endpoints were overall survival(OS) and recurrence-free survival(RFS), assessed via Kaplan-Meier analysis with log-rank testing(statistical significance: p < 0.05).

Results

The LNM incidence demonstrated significant variation across risk groups: low-risk(1.9%), high-risk(12.5%), and intermediate-risk(0%). Survival analysis revealed no statistically significant difference in long-term OS between the surgical and non-surgical groups(5-year OS:100.0%vs91.2%,p=0.107). However, a significant disparity was observed in RFS, with the surgical group demonstrating superior outcomes compared to the non-surgical group(5-year RFS:100.0%vs.76.0%,p=0.009).Subgroup analysis revealed no significant difference in 5-year OS between surgical and non-surgical low-risk patients(100.0%vs88.9%,p=0.276), but RFS differed significantly(100.0%vs70.7%,p=0.046). Among intermediate/high risk patients, neither 5-year OS(100.0%vs96.0%,p=0.270) nor RFS(100.0% s93.8%, p=0.303) showed significant differences between groups.

Conclusion

The eCura scoring system effectively stratifies LNM risk in eCura C-2 patients, aiding treatment selection. While conservative strategy with close surveillance may be appropriate for elderly patients with severe comorbidities, surgical intervention improves long-term outcomes in operable candidates.

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Stomach & H. Pylori Mechanisms & Personalised Medicine Immunology Oesophagus

Submission format

Abstract

Session

Mapping molecular interactions in the upper gastrointestinal tract

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Presentation

New

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IBS patient: To treat or to scope

Christopher Black 1

Affiliations

1 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Hepatobiliary Primary Care Neurogastroenterology & Motility Endoscopy

Session

Cross-cutting: Diagnostic - invasive or not invasive

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Panel discussion: How to make and not miss the diagnosis: Coeliac disease across the spectrum

How do we monitor this patient?

Virginia Solitano

Guiding the care of hypertriglyceridemia-induced acute pancreatitis: Multidisciplinary care and the role of new therapies through apoC-III inhibition (Sobi (Swedish Orphan Biovitrum)) (Complete Session)

Clara Viñals

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Jing2 Zhang

IBS patient: To treat or to scope

Christopher Black

IMPACT OF SICKLE CELL DISEASE ON THE COURSE OF INFLAMMATORY BOWEL DISEASE AND DRUG SAFETY PROFILE: A MULTICENTER STUDY

Matthieu Uzzan

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IMPACT OF SICKLE CELL DISEASE ON THE COURSE OF INFLAMMATORY BOWEL DISEASE AND DRUG SAFETY PROFILE: A MULTICENTER STUDY

Pamela Freiha 1, Julien Kirchgesner 2, Alexandre Nuzzo 3, Iradj Sobhani 4, Pablo Bartolucci 5, Matthieu Uzzan 6

Affiliations

1 Henri Mondor Hospital , Assistance Publique -Hopitaux de Paris, Creteil, France

2 Saint-Antoine Hospital , Assistance publique-Hopitaux de Paris, Paris, France

3 Beaujon Hospital, Assistance publique-Hopitaux de Paris, Paris, France

4 Henri Mondor Hospital , Assistance publique-Hopitaux de Paris, Creteil, France

5 Henri Mondor Hospital, Assistance publique-Hopiatux de Paris, Creteil, France

6 Henri Mondor Hospital , Assistance publique -Hopitaux de Paris, Creteil, France

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Abstract

Introduction

While patients with Sickle Cell Disease (SCD) often exhibit digestive manifestations, the underlying pathophysiology remains poorly understood. SCD could notably affect the intestinal mucosa through microvascular phenomena. Co-occurrence of SCD and Inflammatory Bowel Diseases (IBD) has been reported in a very limited number of cases.
Our aim was to explore the intersection between SCD and IBD, particularly focusing on the impact of SCD on the natural course of IBD and the safety profile of drugs in this high-risk population.

Aims & Methods

We conducted a multicenter retrospective case-control study involving all adult patients diagnosed with both IBD and concomitant SCD and followed in 3 tertiary university hospitals. Each IBD patient with SCD was matched with up to 4 IBD patients without SCD, based on disease phenotype (UC or CD), sex, date of birth (±3 years), length of disease follow-up (±2 years), and year of diagnosis (±3 years). The primary outcome was a complicated disease course, defined by a composite outcome including intestinal resection, perianal surgery, and/or the need for advanced therapy.

Results

Overall, 125 patients with IBD were studied, including 24 with concomitant SCD and 101 controls. Of the 24 SCD patients, 5 (20.8%) had Crohn's disease (CD), 17 (70.8%) had ulcerative colitis (UC) and 2 (8.3%) had indeterminate colitis. 23/24 (95 %) had colonic involvement. Of note, 8 of 24 (33.3%) SCD patients had concomitant primary sclerosing cholangitis (PSC) compared to 1% of patients in the control group (p<0.001). Survival without a complicated course of the disease was estimated at 58.7 % (IC95[49.6-69.5]) at 5 years and at 38.9% (IC95[29.9-50.4]) at 10 years, for non-SCD patients, and at 63.3% (IC95[45.7-87.6]) and 52.7% (IC95[34.9-79.6]) at 5 and 10 years, respectively, for patients with SCD and IBD (p=0.36, Log-rank test). The survival without the need of advanced therapy was estimated at 66.1% (IC95[57.3-76.2]) at 5 years for non-SCD patient, and at 78.2% (IC95[63-97.2]) in patients with SCD patients (p=0.45).
Regarding the safety profile, 26.3% (5/19) of patients with SCD and 13.5 % (14/104) of controls experienced adverse events with advanced therapies (p=0.17, Fisher’s exact test). There was one reported vaso-occlusive crisis associated with the use of thiopurines. No death occurred during follow-up.

Conclusion

While patients with SCD and IBD displayed a distinctive phenotype characterized by nearly constant colonic involvement and a high prevalence of associated PSC, the disease natural history of IBD did not differ from that of patients without SCD. Given the notable prevalence of PSC, systematic screening with cholangio-MRI should be considered. Furthermore, no significant safety signal regarding the use of immunomodulator or advanced therapy was raised.

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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