Pancreatic neuroendocrine tumor radiofrequency ablation (EUS-RFA) uses an endoscopic ultrasound scope passed through the mouth. Guided by the ultrasound image, the doctor places a thin needle electrode into the tumor and destroys it with radiofrequency heat, with no skin incision. In a study of 46 patients from seven centers led by NYU Langone Health, 91.1% had a complete or partial response at final follow-up, and tumors shrank by an average of 72%.
In a prospective study at Okayama University Hospital in Japan, all five patients with tumors of 15 mm or less had complete response on CT at 1 and 6 months. This article also covers two 2026 review papers and explains who is eligible, the results, side effects and where the treatment is offered.
Treatment status · EUS-guided radiofrequency ablation is performed for small pancreatic neuroendocrine tumors at university hospitals in the US, Europe and Japan. It is not yet a standard replacement for surgery. The studies below are a multicenter analysis, a registered prospective study in Japan (jRCTs062230014) and a meta-analysis, all in human patients. This article is general information, not a treatment recommendation.
What is a pancreatic neuroendocrine tumor?
A pancreatic neuroendocrine tumor (PanNET) grows from hormone-producing cells of the pancreas. It is different from the common type of pancreatic cancer (ductal adenocarcinoma) and usually grows slowly. More small tumors of about 1 cm are now found by chance on scans done for other reasons.
Nonfunctional tumors release no excess hormone and cause no symptoms, while insulinomas release insulin and cause episodes of low blood sugar. Surgery has been the main treatment, but pancreatic surgery is major and recovery takes time. Small nonfunctional tumors under 2 cm are often followed with regular scans instead. EUS-guided RFA is being studied as an option between these two approaches.
| Approach | What it involves | Key points |
|---|---|---|
| Surgery | Removing the part of the pancreas with the tumor | Long-established treatment; longer hospital stay and recovery |
| Surveillance | Regular CT, MRI or endoscopic ultrasound | Common for nonfunctional tumors under 2 cm |
| EUS-guided RFA | Needle electrode placed from inside the stomach or duodenum | No skin incision; can be repeated if needed |
Based on Tringali A, Caiazzo A. World J Gastrointest Endosc 2026 and NYU Langone's study summary.
How EUS-guided RFA is done
The scope is passed through the mouth like a gastroscopy. From the stomach or duodenum the pancreas is seen clearly on ultrasound. A 19-gauge needle electrode is placed in the tumor and radiofrequency current produces heat. Larger tumors receive several applications. At Okayama the median procedure time was 16 minutes.
The heating principle is the same as radiofrequency ablation for liver or lung tumors; only the route differs. See our RFA guide and IVR guide.
US study of 46 patients: 91% response
Tamas A. Gonda, MD, and colleagues at NYU Langone Health reported 46 patients treated at seven tertiary centers from 2021 to 2024 in Techniques and Innovations in Gastrointestinal Endoscopy (2026). All had biopsy-confirmed nonfunctional tumors under 3 cm without metastasis; mean size was 12.7 mm and most were grade 1. Technical success was 100%.
| Time point | Complete response | Partial response | Little or no response |
|---|---|---|---|
| First follow-up (mean 4.5 months) | 32.6% | 47.8% | 19.6% |
| Final follow-up (mean about 16 months) | 60.0% | 31.1% | 8.9% |
Overall response 91.1%; mean tumor size reduction 72%. From NYU Langone and AGA reports of the study.
Of 31 patients with a partial or no response at first follow-up, 18 had a repeat session, usually just one, and 44.4% of them converted to complete response. About one-third of those without a repeat session also reached complete response over time. "Not everyone responded equally, but almost everyone eventually responded," Dr. Gonda said. A 7- or 10-mm electrode tip (versus 5 mm) and more applications favored early complete response.
Prospective study at Okayama University
Okayama University Hospital enrolled patients from May 2023 to December 2024 under a prespecified protocol and published in DEN Open (2025). Eligible tumors were grade 1, 15 mm or less, confirmed by biopsy.
| Item | Result |
|---|---|
| Patients | 5 (median age 64; median tumor 10 mm) |
| Complete response on contrast CT | 100% at 1 and 6 months |
| Median procedure time | 16 minutes |
| Median hospital stay | 5 days |
| New or worse diabetes | None |
| Severe adverse events | None |
Matsumoto K, et al. DEN Open 2025;5:e70073 (jRCTs062230014).
Japanese meta-analysis of 26 studies
The Okayama team pooled 26 studies published from 2005 to April 2025 in Therapeutic Advances in Gastroenterology (January 2026), comparing RFA with EUS-guided ethanol injection.
| Tumor type | RFA clinical success | Ethanol injection |
|---|---|---|
| Insulinoma | 95% | 77% |
| Nonfunctional tumor | 85% | 76% |
Matsumoto K, et al. Ther Adv Gastroenterol 2026;19.
Results were especially strong for insulinoma. A 2026 Italian review of 29 studies (230 patients) with functioning tumors found clinical success of 100% in most studies.
Side effects and management
The most common problems are abdominal pain and pancreatitis, usually mild and settled with fasting, fluids and pain relief. In the NYU study 7 of 46 patients (15%) had adverse events, and none occurred after repeat sessions.
| Study | Adverse events | Outcome |
|---|---|---|
| US, 46 patients | 15%, mainly pain and pancreatitis | One partial pancreatectomy for a duct stricture; one bleed treated in hospital |
| Japan, 5 patients | Asymptomatic pseudocyst in 2, mild pancreatitis in 1 | All resolved with conservative care |
| Meta-analysis | Fluid collection 1.9%, duct stricture 1.4% | Mostly mild; one death reported in a 97-year-old |
The authors stress careful patient selection. Ask about pancreatitis prevention and the follow-up plan before treatment.
Who may be eligible
- Small nonfunctional tumors: biopsy-confirmed, no metastasis; under 3 cm in the US study and grade 1 tumors of 15 mm or less in Japan.
- Insulinoma: with low blood sugar symptoms and a tumor well seen on endoscopic ultrasound.
- Patients for whom surgery is a burden: older age, other illnesses, or a wish to avoid surgery.
- Usually not suitable: metastatic or higher-grade tumors, or tumors pressed against the pancreatic duct or large vessels.
Jad AbiMansour, MD, of Mayo Clinic noted that many centers observe tumors until they reach 2 cm and that research on patient selection should continue. Decisions are best made by a multidisciplinary team. Related reading: pancreatic cancer NanoKnife (IRE) and the PELICAN trial of RFA for pancreatic cancer.
Availability in Japan and abroad
| Region | Status | Basis |
|---|---|---|
| United States | Performed at NYU Langone and other university hospitals; seven-center analysis published | 2026 study |
| Japan | Performed at Okayama University Hospital under a registered study; meta-analysis published | jRCTs062230014; 2026 meta-analysis |
| Europe | Growing reports from Italy, France and others | 2026 review |
Foreign patients are usually not covered by national insurance, so confirm costs and schedules with each hospital.
For an overseas consultation, prepare recent contrast CT or MRI, the endoscopic ultrasound biopsy report (with Ki-67 and grade), and somatostatin receptor PET if done. For insulinoma, bring blood sugar records and blood tests.
Questions to ask your doctor
- For my tumor size and grade, is surveillance, surgery or RFA the best fit?
- How far is the tumor from the pancreatic duct and blood vessels?
- How are the electrode length and number of applications chosen?
- What steps reduce the risk of pancreatitis?
- When are follow-up scans done, and when is a repeat session considered?
See also five questions before an RFA consultation.
Frequently asked questions
Is a pancreatic neuroendocrine tumor the same as pancreatic cancer?
No. Common pancreatic cancer is an adenocarcinoma of the duct cells, while neuroendocrine tumors arise from hormone-producing cells. Most grow slowly and are treated differently.
Is one RFA session enough?
In the NYU study about one-third reached complete response after the first session; with repeat sessions where needed, 60% had complete response and 91.1% responded at final follow-up.
How long is the hospital stay?
The median stay at Okayama was 5 days. It varies by hospital and country and may be longer if pancreatitis occurs.
Can insulinoma be treated this way?
In the Japanese meta-analysis, clinical success of RFA for insulinoma was 95%, judged by relief of low blood sugar. Suitability depends on tumor location and size.
This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked October 30, 2026)
- Gonda TA, Mahadev S, et al. Endoscopic ultrasound-guided radiofrequency ablation for nonfunctional pancreatic neuroendocrine tumors: a multicenter analysis. Techniques and Innovations in Gastrointestinal Endoscopy. 2026.
- NYU Langone Health. New Study Strengthens the Case for EUS-RFA in NF-PanNETs. Physician Focus. 2026.
- American Gastroenterological Association. EUS-RFA may offer nonsurgical option for small PanNETs. AGA News. July 30, 2026.
- Matsumoto K, Uchida D, Takeuchi Y, et al. Efficacy and safety of endoscopic ultrasonography-guided radiofrequency ablation of small pancreatic neuroendocrine neoplasms: A prospective, pilot study. DEN Open. 2025;5(1):e70073.
- Matsumoto K, Fujii Y, Uchida D, Takeuchi Y, Mitsuhashi T, Otsuka M. Clinical efficacy and safety of endoscopic ultrasound-guided ablation therapies for pancreatic neuroendocrine tumors: a systematic review and meta-analysis. Therapeutic Advances in Gastroenterology. 2026;19.
- Tringali A, Caiazzo A. Role of endoscopic ultrasound in the treatment of pancreatic neuroendocrine tumors: Lights and shadows of endoscopic ultrasound-guided radiofrequency ablation. World Journal of Gastrointestinal Endoscopy. 2026;18(1):113617. doi:10.4253/wjge.v18.i1.113617