Clinical Endoscopy

Current role of endoscopic ablation in the management of pancreatic cancer: Tae In Kim, Jonghyun Lee, Ho Seung Lee, Sung Yong Han, Jae Min Lee; Received July 4, 2025 Accepted December 11, 2025 Published online March 16, 2026; DOI: https://doi.org/10.5946/ce.2025.216 [Epub ahead of print]

Abstract PDF: Pancreatic cancer remains one of the most challenging malignancies to treat, with its incidence steadily rising owing to factors such as aging populations, lifestyle changes, and improved diagnostic capabilities. Surgery is an essential treatment; however, most patients are diagnosed at advanced stages. Conventional therapies offer limited survival benefits, underscoring the need for innovative approaches. Local treatments have emerged as critical strategies for improving tumor control and patient outcomes, particularly in unresectable or metastatic cases. Recent advancements include refinements in radiofrequency ablation (RFA), stereotactic body radiotherapy, irreversible electroporation, cryotherapy, and brachytherapy. RFA is a well-known modality that has been used effectively for the treatment of solid tumors such as hepatocellular cancer and cholangiocarcinoma. Cryotherapy offers targeted ablation with extreme cold, minimizing damage to surrounding tissues, whereas brachytherapy delivers localized radiation with precision, enhancing efficacy and reducing systemic toxicity. Nanoparticle-based drug delivery systems are an emerging trend in immunotherapy and advanced imaging techniques. This review evaluates advancements and declines in local treatments for unresectable pancreatic cancer. It underscores the importance of addressing rising pancreatic cancer rates through personalized approaches, robust clinical trials, and multidisciplinary collaboration to optimize therapeutic outcomes.

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Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents: Sung Yong Han; Clin Endosc 2025;58(5):698-700. Published online September 1, 2025; DOI: https://doi.org/10.5946/ce.2025.210

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Evaluation of cryoablation using a prototype cryoablation needle in swine liver: Hyunjoon Son, Jonghyun Lee, Sung Yong Han, Tae In Kim, Dong Uk Kim, Daejin Kim, Gun-Ho Kim; Clin Endosc 2024;57(5):675-682. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.024

Graphical Abstract Abstract PDF

Background
/Aims: Pancreatic cancer poses significant challenges due to its tendency for late-stage diagnosis and high mortality rates. Cryoablation, a technique used to treat various types of cancer, has shown potential in enhancing the prognosis of pancreatic cancer when combined with other therapies. However, its implementation is often limited by the need for lengthy procedures and specialized equipment. This study aims to develop a cryoablation needle optimized for endoscopic ultrasonography to simplify its application in treating pancreatic cancer.
Methods
The study involved conducting cryoablation experiments on swine liver tissue. It utilized cryo-needles to evaluate the extent of cell death across various temperatures and durations of cryoablation.
Results
The cryoablation system, which employed liquid carbon dioxide, achieved rapid cooling, reaching temperatures below –60 °C within 30 seconds and maintained the cryoablation process for 200 seconds. These conditions resulted in necrosis of the liver tissue. Notable cellular changes were observed up to 15 mm away from the cryoablation needle.
Conclusions
This experimental study successfully demonstrated the efficacy of using a cryo-needle for cryoablation in swine liver tissue. Further trials involving pancreatic tissue are expected to verify its effectiveness, underscoring the importance of continued research to establish its role as a complementary therapy in pancreatic cancer treatment.

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Cryoablation temperature monitoring with dense ultrasonic speed-of-sound shift imaging
Gaya Lamm, Tal Grutman, Mike Bismuth, Tali Ilovitsh
Physics in Medicine & Biology.2026; 71(10): 105008. CrossRef

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Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?: Jonghyun Lee, Sung Yong Han; Clin Endosc 2024;57(3):332-334. Published online May 23, 2024; DOI: https://doi.org/10.5946/ce.2024.035

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Quality indicators of endoscopic ultrasound in the pancreatobiliary system: a brief review of current guidelines: Sung Yong Han, Hyung Ku Chon, Seong-Hun Kim, Sang Hyub Lee, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2024;57(2):158-163. Published online June 9, 2023; DOI: https://doi.org/10.5946/ce.2023.064

Abstract PDF

Since its development, the use of endoscopic ultrasonography (EUS) in the pancreas and the biliary tract has become increasingly important. The accuracy of EUS varies depending on the experience of the endoscopist. Hence, quality control measures using appropriate indicators are required to reduce these variations. American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have announced the EUS quality indicators. Here, we reviewed the quality indicators of the EUS procedure in the current published guidelines.

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Role of endoscopic ultrasonography in differential diagnosis of gallbladder wall thickening: a multi-center retrospective study
Min Woo Lee, Seong-Hun Kim, Woo Hyun Paik, Se Woo Park, Dong Wook Oh, Dong Kee Jang, Hyung Ku Chon, Sung Ill Jang, Jin Ho Choi, In Rae Cho, Ji Kon Ryu, Jae Hee Cho, Sang Hyub Lee
HPB.2026; 28(3): 324. CrossRef
Results of Endoscopic-Ultrasound Tissue Acquisition (EUS-TA) for Solid Pancreatic Lesions: 13 years’ real-world experience of academic oncological center
L Lenz, S Matuguma, B Martins, G Andrade De Paulo, R Almeida, C Cesar, A Pombo, A Machado, R Nobre, L Felipe, A Safatle-Ribeiro, F Maluf-Filho
Endoscopy.2026; 58(S 03): S551. CrossRef
A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim, Dong Chan Joo
Clinical Endoscopy.2024; 57(2): 268. CrossRef

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Convex versus Radial Echoendoscopes - Comparison of Capability for Evaluating the Pancreatobiliary Junction: Sung Yong Han, Dong Uk Kim; Clin Endosc 2018;51(3):211-212. Published online May 16, 2018; DOI: https://doi.org/10.5946/ce.2018.065

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Evaluation of a novel radial echoendosonoscope with a piezoelectric-composite transducer
Sheng Wang, Jintao Guo, Xiang Liu, Nan Ge, Guoxin Wang, Jinlong Hu, Kai Zhang, Siyu Sun
Endoscopic Ultrasound.2021; 10(6): 431. CrossRef

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Bile Duct Patency Maintained after Intraductal Radiofrequency Ablation in a Case of Hepatocellular Cholangiocarcinoma with Bile Duct Invasion: Sung Yong Han, Geun Am Song, Dong Uk Kim, Dong Hoon Baek, Moon Won Lee, Gwang Ha Kim; Clin Endosc 2018;51(2):201-205. Published online August 31, 2017; DOI: https://doi.org/10.5946/ce.2017.097

Abstract PDF

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with bile duct invasion (BDI) is rare. In unresectable cases, biliary stent placement and photodynamic therapy (PDT) are used for resolving obstructive jaundice. However, stent occlusion remains problematic, and PDT is expensive and time-consuming. Intraductal radiofrequency ablation (RFA) is an emerging procedure for palliation in these patients. It has potential benefits including less expense, lower rates of severe complication, longer maintenance of ductal patency, and easier technique compared with PDT or stenting alone. We report a 67-year-old man who underwent repeated intraductal RFA for HCC-CC and HCC with BDI (HCC-BDI), for whom bile duct patency was maintained without additional biliary procedures.

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Clinical and cost effectiveness of endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstruction: a systematic review
Fiona Beyer, Stephen Rice, Giovany Orozco-Leal, Madeleine Still, Hannah O’Keefe, Nicole O’Connor, Akvile Stoniute, Dawn Craig, Stephen Pereira, Louise Carr, John Leeds
Health Technology Assessment.2023; : 1. CrossRef
Improving biliary stent patency for malignant obstructive jaundice using endobiliary radiofrequency ablation: experience in 150 patients
Ya-Lin Kong, Hong-Yi Zhang, Cheng-Li Liu, Xiao-Jun He, Gang Zhao, Cheng Wang, Ling-Hong Kong, Jing Zhao
Surgical Endoscopy.2022; 36(3): 1789. CrossRef

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