Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation (EUS-RFA) for Pancreatic Neoplasms: Results From an International Survey

Background and Aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real-world practice among international users.Methods A cross-sectional 70-item survey was conducted. Results are presented descriptively (numbers, percentages).Results Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS-RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS-RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located <= 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post-procedural management and follow-up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post-RFA pancreatitis.Conclusions Despite the global expansion of EUS-RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high-quality evidence.