Endoscopic ultrasound-guided fine needle injection of alcohol for ablation of an insulinoma: a well documented successful procedure

Silva, Flávio Amaro Oliveira Bitar; Colaiácovo, Rogério; Araki, O; Domene, Anna Fernanda C.; Lima, Jose Viana; Moricz, André de; Rossini, Lucio G.

doi:10.1055/a-0820-1053

Cited by 7 publications

(13 citation statements)

References 5 publications

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“…Body mass index was only reported in six cases. 10 , 22 , 29 , 31 , 37 , 46 In 5 female and 1 male patient, the average age was 55 (range: 21–78) years. Obesity (BMI > 40 kg/m 2 ) was recorded in four cases.…”

Section: Resultsmentioning

confidence: 99%

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Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

Sayed

Frim

Franklin

et al. 2021

Therap Adv Gastroenterol

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Background: Insulinoma is the most common neuroendocrine neoplasm of the pancreas, characterised by hypoglycaemic symptoms. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and ethanol ablation (EUS-EA) are novel methods for treating insulinoma. We aimed to perform a systematic review to assess the efficacy and safety of EUS-guided ablation techniques for pancreatic insulinomas. Methods: We systematically searched for articles detailing EUS-guided ablations of insulinomas. We performed a qualitative analysis and summarised data on the efficacy and safety of EUS-RFA and EUS-EA techniques. Results: In total, we identified 35 case reports and case series describing 75 patients with insulinomas treatment with EUS-guided ablation. Twenty-seven patients were treated with EUS-RFA, 47 patients with EUS-EA, and 1 patient received EUS-EA and EUS-RFA in the same session. In total, 84 insulinomas were ablated (EUS-RFA: 31, EUS-EA: 53). Most insulinomas were in the head of the pancreas (40%). The clinical success rate for EUS-guided ablation techniques was 98.5%. The median glucose level was 1.95 (Q1-Q3: 1.69–2.13) mmol/L before ablation compared to 6.20 (Q1-Q3: 5.30–7.05) mmol/L after treatment. The median insulin and C-peptide levels before and after RFA/EA were 230 (Q1–Q2: 120–257) pmol/L and 41 (Q1–Q2 35–42) pmol/L; 2077 (Q1–Q2 1644–2459) pmol/L and 819 (Q1–Q2 696–1072) pmol/L, respectively. There were eleven adverse events: seven abdominal pain, two mild acute pancreatitis, one necrotising acute pancreatitis and one local hematoma. All patients recovered, and there were no periprocedural deaths. Conclusions: EUS-guided ablation of insulinoma seems to be a safe and effective treatment and is an alternative to surgical resection in selected cases.

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Section: Resultsmentioning

confidence: 99%

“…Our results demonstrated that 21 out of 65 patients (32% of all cohort) had multiple co-morbidities, which precluded surgical intervention; however, EUS-guided RFA/EA was successful in them. 6 , 16 , 22 , 23 , 25 – 29 , 31 , 36 – 39 , 41 , 42 , 45 , 46 , 48 – 52…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

Sayed

Frim

Franklin

et al. 2021

Therap Adv Gastroenterol

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“…Subsequent case reports and small case series have been published describing the use of EUS‐EA for both F‐PanNENs and NF‐PanNENs. Up to December 2019, 83 patients with 96 lesions have been treated by EUS‐EA20–42 (Table 2). The success rate was 94.7% for F‐PanNENs and between 50% and 62.5% for NF‐PanNENs (Table 3).…”

Section: Eus‐guided Ethanol Ablationmentioning

confidence: 99%

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

Rimbaș

Horumba

Rizzatti

et al. 2020

Digestive Endoscopy

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The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS‐guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre‐operative EUS‐guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS‐guided loco‐regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS‐guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.

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“…However, insulinomas are very small lesions that can be difficult to locate in the pancreas, therefore, extensive pre-and intraoperative explorations are required to optimise surgical management. As an alternative to surgery, endoscopic ultrasound-guided ablation therapies with ethanol or by radiofrequency have recently been developed, with limited available data to date [46][47][48].…”

Section: Insulinomasmentioning

confidence: 99%

Surgical Management of Neuroendocrine Tumours of the Pancreas

Souche

Hobeika

Hain

et al. 2020

JCM

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Neuroendocrine tumours of the pancreas (pNET) are rare, accounting for 1–2% of all pancreatic neoplasms. They develop from pancreatic islet cells and cover a wide range of heterogeneous neoplasms. While most pNETs are sporadic, some are associated with genetic syndromes. Furthermore, some pNETs are ‘functioning’ when there is clinical hypersecretion of metabolically active peptides, whereas others are ‘non-functioning’. pNET can be diagnosed at a localised stage or a more advanced stage, including regional or distant metastasis (in 50% of cases) mainly located in the liver. While surgical resection is the cornerstone of the curative treatment of those patients, pNET management requires a multidisciplinary discussion between the oncologist, radiologist, pathologist, and surgeon. However, the scarcity of pNET patients constrains centralised management in high-volume centres to provide the best patient-tailored approach. Nonetheless, no treatment should be initiated without precise diagnosis and staging. In this review, the steps from the essential comprehensive preoperative evaluation of the best surgical approach (open versus laparoscopic, standard versus sparing parenchymal pancreatectomy, lymphadenectomy) according to pNET staging are analysed. Strategies to enhance the short- and long-term benefit/risk ratio in these particular patients are discussed.

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Endoscopic ultrasound-guided fine needle injection of alcohol for ablation of an insulinoma: a well documented successful procedure

Cited by 7 publications

References 5 publications

Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

Surgical Management of Neuroendocrine Tumours of the Pancreas

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