Endoscopic, ultrasound guided, radiofrequency ablation of aldosterone producing adenomas: A prospective, proof-of-concept trial
Year: 2024
Type: preprint
Study design: Clinical Trial
Abstract: Unilateral aldosterone-producing adrenal adenomas (APAs) are the potentially curable cause of 5% of all cases of hypertension. At present surgical removal of a whole gland is the only approved option for achieving cure, with uncertain long-term outcomes. Endoscopic ultrasound-guided trans-gastric radiofrequency ablation (EUS-RFA) offers a less invasive alternative to total adrenalectomy for the treatment of left-sided APAs. We aimed to determine whether EUS-RFA of APAs is safe and evaluate its likelihood of success in curing primary aldosteronism. We conducted a multi-centre feasibility study of EUS-RFA as a nonsurgical, adrenal-sparing treatment for left-sided APAs. The primary endpoint was safety, judged by the occurrence of pre-specified major hazards (intestinal haemorrhage, infarction or viscus perforation); and the secondary endpoints were biochemical and clinical efficacy (Primary Aldosterone Surgical Outcome (PASO) criteria). 28 participants (21 male, 7 female, mean age 57.7 +/- 10.3 years; 16 White, 11 Black, 1 Asian), underwent 35 ablations on one (n=21) or two (n=7) occasions. None of the pre-specified major hazards occurred. There were 21 biochemical and 12 clinical successes. These were complete in 16 and 4 participants, respectively, associated with >75% eradication of the APA, judged by molecular imaging. EUS-guided trans-gastric RFA is a safe alternative to total adrenalectomy for the treatment of left-sided APAs and can lead to complete PASO success when most of the APA is ablated.
Source: Research Square
Authors: Morris Brown, Giulia Argentesi, Xilin Wu, Alexander Ney, Emily Goodchild, Kate Laycock, Yun-Ni Lee, Russell Senanayake, James MacFarlane, Elisabeth Ng, Jessica Kearney, Samuel O'Toole, August Palma, Iulia Munteanu, Jackie Salsbury, Elena Benu, Patrizia Ebano, Nick Carroll, Daniel Gillett, John Tadross, Alison Marker, Patrick Wilson, Edmund Godfrey, George Goodchild, Jonathan Bestwick, Mark Gurnell, Heok Cheow, Stephen Pereira, William Drake
Institutions: NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, William Harvey Research Institute, University College London, Wellcome/MRC Institute of Metabolic Science, NIHR Cambridge Biomedical Research Centre, University of London, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Barts Health NHS Trust, Addenbrooke's Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G2537968379, G5863237102
OpenAlex ID: W4396765061