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Gemelli IRCCS, Rome, Italy; 2 Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania; 3 Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania; 4 Department of Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 5 Department of Medical‑Surgical Sciences and Translational Medicine, Digestive Disease Unit, ENETS Center of Excellence, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy  \nABSTRACT  \nSurgery has been regarded as the only curative treatment for patients with small nonfunctional pancreatic neuroendocrine neoplasms (NF‑PNENs) less than 2 cm. Duetothe significant adverse event rates of surgery, the European Neuroendocrine Tumor Society issued guidelines favoring surveillance for those patients lacking criteria suggestive of an aggressive disease. Despite the above recommendations, a significant proportion of small NF‑PNEN patients still undergo surgery. Recently, several studies have reported the safety and effectiveness of EUS‑guided radiofrequency ablation (RFA) for the treatment of small NF‑PNENs. The experience with EUS‑RFA is, however, limited, but published results indicate a potential role as a minimally invasive alternative treatment for these patients, in particular in those in whom further progression is more probable, before they reach the absolute need for surgery. A step‑up approach with EUS‑RFA followed by surgery for the failure cases can become a valid option to be validated in clinical studies.  \nKey words: EUS, Pancreatic neuroendocrine neoplasms, non-functional, radiofrequency ablation, step-up treatment, surgery  \nINTRODUCTION  \nSurgery, with both typical and atypical resections, has traditionally been the leading treatment of nonfunctional pancreatic neuroendocrine neoplasms (NF-PNENs), with a proven significant benefit in terms of survival. [1] However, substantial short- and long-term adverse events (AEs) occur, even in very  \n\n| Access this article online |  |\n| --- | --- |\n| Quick Response Code:\u003Cbr>| Website:\u003Cbr>[www.eusjournal.com](www.eusjournal.com) |\n|  | DOI:\u003Cbr>10.4103/EUS-D-22-00028 |\n\nexpert hands. Indeed, in a recent systematic review of the literature including 62 studies, postoperative pancreatic fistula, delayed gastric emptying, hemorrhage, and inhospital mortality have been respectively reported in 14%–58%, 5%–18%, 1%–7%, and 3%–6% of the  \nThis is an open access journal, and articles are distributed under the terms of the Creative CommonsAttribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.  \n[For reprints contact:](For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com)  \nHow to cite this article: Rimbaș M, Rizzatti G, TosoniA, Impagnatiello M, Panzuto F, Larghi A. Small nonfunctional pancreatic neuroendocrine neoplasms: Time for a step-up treatment approach? Endosc Ultrasound 2023;12:1-7 .  \nAddress for correspondence  \nDr. Alberto Larghi, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy. E-mail: [alberto.larghi@policlinicogemelli.it](alberto.larghi@policlinicogemelli.it)  \nReceived: 2022-02-01; Accepted: 2022-08-01; Published online: 2022-11-30  \n © 2022 SCHOLAR MEDIA PUBLISHING | PUBLISHED BY WOLTERS KLUWER - MEDKNOW  \nRimbaș , et al.: Step-up therapeutic app","cbCailSDinAVuOxY","https://ap.wps.com/l/cbCailSDinAVuOxY","pdf",1176964,"English","# Abstract\n# Introduction\n# Strategies for Small NF-PNENs\n## Watchful surveillance criteria\n## EUS-guided radiofrequency ablation and step-up approach","[{\"question\":\"Why is surveillance considered for small nonfunctional pancreatic neuroendocrine neoplasms under 2 cm?\",\"answer\":\"Surveillance is favored due to the significant adverse event rates associated with surgery. ENETS guidelines recommend less aggressive management when criteria suggesting aggressive disease are absent.\"},{\"question\":\"What role does EUS-guided radiofrequency ablation (RFA) play in the proposed approach?\",\"answer\":\"Published results suggest that EUS-RFA may offer a safe and effective minimally invasive alternative for small NF-PNENs, particularly before an absolute need for surgery arises.\"},{\"question\":\"What is the “step-up” treatment strategy described in the article?\",\"answer\":\"A step-up approach uses EUS-RFA first, then proceeds to surgery only for failure cases, with the strategy proposed to be validated through clinical studies.\"}]","Small nonfunctional pancreatic neuroendocrine neoplasms: Time for a step-up treatment approach? | PDF",1790264303,18]