Endoscopic ultrasound-guided radiofrequency ablation: An effective and safe alternative for the treatment of benign insulinoma

Furnica, Raluca Maria; Deprez, Pierre Henri; Maiter, Dominique; Vandeleene, Bernard; Borbath, Ivan

doi:10.1016/j.ando.2020.11.009

Cited by 24 publications

(13 citation statements)

References 22 publications

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“…A recent systematic review and meta-analysis that included 53 cases of pNET revealed a pooled clinical success rate (symptomatic improvement along with decrease in size and necrosis) ranging from 83 % to 100 % 17 . We have already reported preliminary results of the significant benefit of RFA to patients with insulinoma 22 . Here, all 13 patients with insulinomas exhibited an immediate and sustained complete clinical response, with no symptoms of hypoglycemia recurring during follow-up, at the cost of very low toxicity.…”

Section: Discussionmentioning

confidence: 99%

EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study

et al. 2022

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BACKGROUND AND AIMS : Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging and minimally invasive technique, which seems promising for the treatment of focal pancreatic and peripancreatic lesions. Our aim was to prospectively evaluate the feasibility, safety, technical and clinical success of pancreatic and extra-pancreatic EUS-RFA. METHODS : We prospectively collected clinical and technical data regarding all patients submitted to EUS-RFA in two Belgian academic centers, from June/2018 to February/2022. Feasibility, adverse events and follow-up were also assessed. RESULTS : Twenty-nine patients were included, accounting for thirty-five lesions : 10 non-functioning neuroendocrine tumors (29%), 13 pancreatic insulinoma (37%), 1 adenocarcinoma lesion (3%) and, finally, 11 intra and extra-pancreatic metastatic lesions (31%). Technical success was achieved in 100%, with a median of 3 power applications per lesion (IQR 2). The majority of patients (59%) presented no collateral effects, three (10.3%) developed non-severe acute pancreatitis and four (14%) mild abdominal pain. At 6 months follow-up (n=25), 36% of patients showed radiological complete response, 16% presented a significant partial response and 48% showed <50% decrease in diameter. At 12 months (n=20), 30% showed complete necrosis and 15% > 50% decrease in diameter. Hypoglycemia related to insulinoma was immediately corrected in all 13 cases, with no recurrence during follow-up. CONCLUSIONS : EUS-RFA is feasible, safe and effective for the treatment of pancreatic and peripancreatic tumors. Larger and longer multicentric prospective studies are warranted to establish its role in the management of focal pancreatic lesions and oligo-metastatic disease. Symptomatic insulinoma currently represent the best indication.

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Section: Discussionmentioning

confidence: 99%

EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study

et al. 2022

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“…In the present series, EUS-RFA led to symptom relief during a relatively long follow-up, with a single endoscopic session in 2 patients and 2 endoscopic sessions in the remaining patient. Notably, while most of the published case series on this topic did not present specific and standardized ablation settings[ 7 - 10 ], in the present study we standardized the setting of the ablation power in line with previous ex-vivo animal[ 11 ] and human studies (unpublished data), with the application of 30 W and stopping energy delivery when tissue impedance increased. All 3 patients are symptom-free after more than 12 mo of clinical and biochemical follow-up and the lesion is no longer visible after 14 mo in one of the patients who underwent radiological examination.…”

Section: Discussionmentioning

confidence: 92%

Endoscopic ultrasound radiofrequency ablation of pancreatic insulinoma in elderly patients: Three case reports

Rossi¹,

Petrone²,

Capurso³

et al. 2022

WJCC

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BACKGROUND Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been proposed as a local treatment for functional pancreatic neuroendocrine neoplasms in patients unfit for surgery, in order to obtain clinical syndrome regression. Data on the safety and long-term effectiveness of this approach are scarce, and EUS-RFA procedures are not standardized. CASE SUMMARY The present case series reports 3 elderly patients with a pancreatic insulinoma and comorbidities, locally treated by EUS-guided RFA with clinical success in terms of hypoglycemic symptoms. RFA procedures were performed during deep sedation, under EUS control with a 19 G needle, an electrode 5-mm in size at a power of 30 W and multiple RFA applications during the same session in order to treat the whole area of the lesions. Immediate relief of symptoms was evident in 2 patients after the first EUS-RFA, while in the third patient a second endoscopic treatment was needed. All 3 patients are symptom-free without need of medications after 24 mo of follow-up with imaging follow-up showing no disease recurrence. A single adverse event of intraprocedural bleeding occurred, which was successfully treated endoscopically. CONCLUSION EUS-RFA represents an effective and safe alternative to surgery for the treatment of insulinomas in elderly patients at high surgical risk. However, larger multicenter studies with longer follow-up are needed in order to better assess its safety and clinical success.

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“…To date, a quite good number of observational studies with a very limited volume of patients have described the application of EUS-RFA in pancreatic insulinomas [15][16][17][18][19][20][21][22][23][24][25][26][27][28] . These are summarized in Table 3.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

Andreis

Boškoski

Mascagni

et al. 2022

Preprint

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Purpose Insulinomas are rare, functioning pancreatic neuroendocrine neoplasms (pNEN), whose gold standard therapy is surgical resection. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a recent technique that has emerged as minimally invasive therapeutic option for patients with pancreatic lesions not eligible for surgery. In this study, we aimed to describe a series of patients with unresectable pancreatic insulinoma treated with EUS-RFA. Methods This is a single-center, retrospective study including all consecutive patients with functioning pancreatic insulinoma undergoing EUS-RFA for surgical unfitness or surgery refusal, between March 2017 and September 2021. Technical success, radiologic response, and adverse events rate were evaluated. Results A total of 10 patients (mean age: 67.1 ± 10.1 years; F:M 7:3) were enrolled. The mean size of insulinoma was 11.9 ± 3.3 mm. Technical success was achieved in 100% of patients, with an immediate normalization of serum glucose levels. Only one (10%) patient was successfully treated with two RFA sessions. The complete radiologic response within 3 months after EUS-RFA was observed in all patients (100%). Persistent euglycemia was assessed at 6 and 12 months for each treated patient. Three procedure-related early adverse events occurred, including two (20%) cases of mild abdominal pain, and one (10%) case of intraprocedural bleeding with spontaneous hemostasis. No major complications were observed within 48 hours after the procedure. Conclusions Data of this case series suggest that EUS-RFA is a feasible and safe therapeutic approach for unresectable pancreatic insulinomas with long-term efficacy.

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Endoscopic ultrasound-guided radiofrequency ablation: An effective and safe alternative for the treatment of benign insulinoma

Cited by 24 publications

References 22 publications

EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study

EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study

Endoscopic ultrasound radiofrequency ablation of pancreatic insulinoma in elderly patients: Three case reports

Safety and efficacy of EUS-guided radiofrequency ablation for unresectable pancreatic insulinoma: a single-center experience

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