Minimally Invasive Technique Ablates Pancreatic Insulinoma

Miriam E. Tucker, for Medscape

November 18, 2022

The study covered in this summary was published in Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) may be a less invasive alternative to resection of pancreatic insulinomas in patients ineligible for or who refuse surgery.

Why This Matters

  • According to the European Neuroendocrine Tumor Society Consensus Guidelines, surgery is the current therapy of choice for resectable pancreatic neuroendocrine neoplasms and is curative in 90% of patients with insulinoma.

  • Surgical options such as enucleation or distal/partial pancreatectomy may cause adverse events such as pancreatic fistulae, deep vein thrombosis, and pancreatic insufficiency.

  • RFA produces a selective thermal-induced coagulative necrosis of neoplastic tissue, long used to treat other tumor types.

  • Prior studies of EUS-RFA in humans with pancreatic lesions have been limited to case reports and small case series.

Study Design

  • Single-center, retrospective study of 10 patients with functioning pancreatic insulinoma who underwent EUS-RFA between March 2017 and September 2021 due to surgical unfitness in seven patients and surgical refusal in three.

Key Results

  • All insulinomas were identified through EUS evaluation, and EUS-guided fine needle biopsy sampling was performed.

  • Mean tumor size was 11.9 mm (range, 8-19 mm).

  • Technical success was achieved in all patients, with symptomatic and biochemical signs of hypoglycemia disappearing within 24 hours in 9 of the 10 patients after a single EUS-RFA session and the other after one additional session.

  • In two patients, mild post-procedural abdominal pain occurred within 24 hours and was treated with a single administration of non-opioid analgesics.

  • Early bleeding followed by spontaneous hemostasis was reported in one patient.

  • No late procedure-related adverse events were reported.

  • Radiologic complete response, assessed by abdominal contrast-enhanced computed tomography at 90 days after EUS-RFA, was achieved in all 10 treated patients.

  • Both patients who had multiple endocrine neoplasia type 1 also needed systemic octreotide therapy.

  • All patients had clinical remission, defined as the presence of normal serum glucose levels and the absence of hypoglycemia-related symptoms, at 6 and 12 months.

Limitations

  • Retrospective, noncomparative study with a small sample size.

  • Relatively short follow-up.

  • No histopathologic confirmation.

Disclosures

  • Study funding: None.

  • Author disclosures: One author is a consultant for Apollo Endosurgery, Cook Medical, Boston Scientific, and Nitinotes, another consults for Cook Medical, Boston Scientific, and Olympus.

This is a summary of a preprint research study, "Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: A single-center experience," written by Federica Borrelli de Andreis of Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Rome, Italy, and colleagues. It has not yet been peer reviewed.

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