EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers

Gastrointest Endosc. 2022 Jun;95(6):1256-1263. doi: 10.1016/j.gie.2021.11.045. Epub 2021 Dec 10.

Abstract

Background and aims: Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, and preserving surgery is the treatment of choice. EUS-guided radiofrequency ablation (EUS-RFA) is a novel and promising technique that induces tissue necrosis of localized lesions. This article presents a preliminary clinical experience in treating pancreatic insulinomas <2 cm by EUS-RFA, focusing on safety and efficacy.

Methods: The clinical course of patients with pancreatic insulinoma treated by EUS-RFA at 2 tertiary referral centers was analyzed.

Results: Between November 2017 and December 2020, 7 patients were included (6 women; mean age, 66 years). EUS-RFA was feasible in all patients with immediate hypoglycemia relief after only 1 single treatment session; 6 of 7 achieved complete response by cross-sectional imaging and remained asymptomatic (median follow-up, 21 months; range, 3-38). Three patients had minor adverse events. One elderly patient developed a large retrogastric collection 15 days after treatment and died 1 month after EUS-RFA.

Conclusions: Management of pancreatic neuroendocrine tumors <2 cm by EUS-RFA seems to be effective with an acceptable safety profile. However, further evidence focusing on long-term survival and recurrence is needed.

MeSH terms

  • Aged
  • Catheter Ablation* / methods
  • Endosonography / methods
  • Female
  • Humans
  • Insulinoma* / diagnostic imaging
  • Insulinoma* / surgery
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / etiology
  • Pancreatic Neoplasms* / surgery
  • Radiofrequency Ablation* / adverse effects