The role of endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) in liver malignancy: case series and literature review

Percutaneous thermal ablation is widely used as a locoregional treatment for liver malignancies, but its feasibility and efficacy may be limited by unfavorable anatomy and access constraints. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative approach for selected tumor locations, particularly those located in the left lobe or caudate region. We report a two-center case series describing technical feasibility, safety, and short-term imaging outcomes of EUS-RFA in primary and secondary liver malignancies. We retrospectively reviewed five patients who underwent EUS-RFA for liver malignancy at two tertiary centers. Diagnoses included hepatocellular carcinoma (HCC; n = 2), intrahepatic cholangiocarcinoma (iCCA; n = 1), colorectal liver metastasis (CRLM; n = 1), and pancreatic neuroendocrine tumor (PNET) liver metastasis (n = 1). EUS-RFA was performed using linear echoendoscopes and a radiofrequency generator connected to an EUS-RFA needle with a 1-cm active tip. Outcomes included technical success, procedural safety, and radiologic response at follow-up. Technical success was achieved in all five patients (100%). No immediate major procedure-related complications (bleeding, perforation, infection) were observed. At follow-up imaging, both HCC patients demonstrated stable disease at 1 month. The iCCA and CRLM patients demonstrated stable disease at 4 months. The PNET liver metastasis progressed during the longer follow-up period (8 months). In this small retrospective case series, EUS-RFA was technically feasible in carefully selected patients with liver malignancies, and no immediate major procedure-related complications were observed. EUS-RFA may serve as a complementary technique when percutaneous access is technically challenging or not feasible. Larger prospective studies are needed to better define its role in the multidisciplinary management of liver malignancies.