Endoscopic Ultrasound-Guided Radiofrequency Ablation For Treatment Of Benign Insulinoma

Aims An insulinoma is a rare functional neuroendocrine tumor of the pancreas (pNETs) with an incidence of approximately 1/250.000, the majority (90 %) is benign. Insulinomas count to the small pNETs, therefore their detection with conventional imaging (CT, MRI) is sometimes unrewarding. Endoscopic ultrasound (EUS) can detect up to 95 %, consequently should be imaging technique of choice. Surgical resection (tumor enucleation or limited pancreatic resection) is currently standard of care for solitary insulinoma. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as a minimally invasive and local ablative procedure was described as feasible treatment approach with a low periprocedural complications risk in selected patients in the last few years.

The aim of this case series is to reveal the efficacy and safety of EUS-RFA for benign solitary insulinoma.

Methods The data of overall 6 insulinomas, which were diagnosed and verified by biopsy between July 2019 to February 2020, was analysed retrospectively.

Results Two patients underwent primary surgical resection, four patients were treated with EUS-RFA after informed consent was given. We used two different EUS-RFA systems: the 19G Habib needle electrode (10 W, 90 sec, Boston Scientific) and the 19G impedance controlled EUSRA needle electrode (50W, Taewoong). The median diameter of the treated lesions was 12.25mm, all ablated lesions were solitary and had a ki-67 index < 2 %; follow-up was between 1.5 to 6.5 months. In three patients, hypoglycaemia related symptoms disappeared immediately after treatment and rapid normalization of blood glucose levels was observed. In one patient RFA was not successful in first session with the Habib-needle electrode, hence a second ablation with the EUSRA needle was performed; subsequently no further hypoglycaemia was documented in this patient also. No major adverse events occurred in all four patients.

Conclusions EUS-RFA might be an efficient and safe future treatment option for well-differentiated insulinomas; nevertheless, further larger prospective trials are required.

Citation Svoboda C, Pachofszky T, Mitrovits N et al. eP421 ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION FOR TREATMENT OF BENIGN INSULINOMA. Endoscopy 2021; 53: S234.

Publication History

Article published online:
19 March 2021