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SAFETY AND EFFICACY OF ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION FOR PANCREATIC INSULINOMA: A SINGLE-CENTER EXPERIENCE

Federica Borrelli de Andreis 1, Tommaso Schepis 1, Ivo Boskoski 1, Pietro Mascagni 1, Giuseppe Quero 1, Guido Costamagna 2, Cristiano Spada 1, Fabia Attili 1

Affiliations

1 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

2 Università Cattolica del Sacro Cuore, Rome, Italy

Summary

AI Generated

A retrospective case series of 10 patients with pancreatic insulinoma treated with EUS-guided radiofrequency ablation demonstrated 100% technical success, immediate euglycemia, and complete radiological response with minimal adverse events.

All 10 patients (mean age 67.1 years, mean tumor size 11.9 mm) who were unfit for surgery or refused surgery achieved technical success, immediate post-procedural euglycemia, and complete radiological response by CT scan within 90 days
The procedure used a 19G RFA needle with 20-50W energy, median 6 passes, and median 15 seconds ablation duration per pass
Early adverse events were mild abdominal pain in 2 patients (20%) and bleeding in 1 patient (10%), with no late adverse events
Persistent clinical remission was maintained at 6 months (10/10 patients) and 12 months (9/9 patients available for follow-up)
The authors conclude EUS-RFA may be feasible and safe for pancreatic insulinomas with mid-term efficacy; this series is relevant for clinicians managing patients unsuitable for surgical resection

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Insulinomas are rare, functioning pancreatic neuroendocrine neoplasms (pNEN), whose gold standard therapy is surgical resection. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a minimally invasive therapeutic option for pancreatic lesions. This study aims at describing a series of patients with pancreatic insulinoma treated with EUS-RFA.

Aims & Methods

This single-center, retrospective study includes all consecutive patients with pancreatic insulinoma undergoing EUS-RFA because unfit for surgery or refusing surgery. EUS-RFA was performed by using a 19G RFA needle, and a dedicated current generator system with a RFA energy of 20 to 50W. Technical success (i.e., the achievement of complete ablation), adverse events rate, and radiologic response within 3 months after EUS-RFA (i.e., complete tumor necrosis) were evaluated. Follow-up was assessed by clinical monitoring and blood test evaluation at least every 6 months for the first year after the procedure. A descriptive statistical analysis was performed for all the variables.

Results

From March 2017 to September 2022, 10 patients (mean age: 67.1 ± 10.1 years; F:M 7:3) were included. The mean size of insulinomas was 11.9 ± 3.3mm. The median number of passes was 6 (1-14) with a median ablation duration of 15 (6-20) seconds per pass. Technical success, immediate post-procedural euglycemia, and complete radiological response by abdominal CT scan were achieved in all cases (100%). Mild procedure-related early adverse are shown in Table 1. Persistent euglycemia was assessed at 6 and 12 months for each treated patient.

Patients, n	10
Technical success, n (%)	10 (100)
Early adverse events, n (%) Mild abdominal pain Bleeding	2 (20) 1 (10)
Late adverse events, n (%)	0 (0)
Euglycaemia within 24 hours	10 (100)
Radiologic complete response within 90 days, n (%)	10 (100)
Clinical remission at 6 months, n (%)	10 (100)
Clinical remission at 12 months, n (%)	9/9 (100)

Conclusion

Data from this case series suggest that EUS-RFA is a feasible and safe therapeutic approach for pancreatic insulinomas with mid-term efficacy.

References

Waung, J.A.; Todd, J.F.; Keane, M.G.; Pereira, S.P. Successful management of a sporadic pancreatic insulinoma by endoscopic ultrasound-guided radiofrequency ablation. Endoscopy 2016, 48 (Suppl. S1), E144–E145
Goldberg SN, Mallery S, Gazelle GS, Brugge WR. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc. 1999 Sep;50(3):392-401. doi: 10.1053/ge.1999.v50.98847.
Tsoli M, Chatzellis E, Koumarianou A, Kolomodi D, Kaltsas G. Current best practice in the management of neuroendocrine tumors. Ther Adv Endocrinol Metab. 2018 Oct 31;10:2042018818804698. doi: 10.1177/2042018818804698.

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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