EUS-guided radiofrequency ablation is a safe alternative for patients with branch-duct IPMNs showing worrisome features who cannot undergo surgery.

• Technical success was 100% in 62 procedures, with 98% achieving local control.
• Adverse events occurred in 27%, primarily mild abdominal pain; no deaths reported.

This procedure effectively prevents cancer progression in patients unsuitable for traditional surgery.

• Notably, 17% of lesions completely disappeared, and 86% reduced in size during follow-up averaging 4.1 years.