Minimally Invasive Technique Ablates Pancreatic Insulinoma

The study covered in this summary was published in Research Square as a preprint and has not yet been peer reviewed.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