Background and Aims
Insulinomas are one of the most common functional pancreatic neuroendocrine tumors.
Surgical removal is the standard of care. Patients unfit for or refusing surgery need
an alternative nonsurgical method to alleviate symptoms. EUS has been used to localize,
aspirate, and tattoo insulinomas and to inject alcohol for local ablation. This study
is aimed at assessing the feasibility of EUS-guided radiofrequency ablation (EUS-RFA)
for managing patients with a symptomatic insulinoma by using a novel EUS-RFA needle
electrode.
Methods
The EUS-RFA system used consists of a prototype 19-gauge needle electrode, generator,
and internal cooling system. EUS-guided RFA is performed under real-time visualization
at 50 W to ablate pancreatic insulinomas.
Results
In this observational human case series from a tertiary care center, 3 patients with
a symptomatic pancreatic insulinoma, not eligible for surgery, underwent EUS-RFA by
using an internally cooled prototype needle electrode. All had rapid symptom relief
with biochemical improvement and remained symptom free at 11 to 12 months of follow-up.
There were no procedure-related adverse events.
Conclusions
EUS-RFA with the novel device can be considered in select patients with a symptomatic
pancreatic insulinoma based on preliminary findings of a beneficial effect without
adverse events. Assessment of the safety profile requires larger prospective trials.
Abbreviations:
CECT (contrast-enhanced CT), EUS-RFA (EUS–guided radiofrequency ablation), PNET (pancreatic neuroendocrine tumor), RFA (radiofrequency ablation)To read this article in full you will need to make a payment
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References
- Accurate preoperative localization of insulinomas avoids the need for blind resection and reoperation: analysis of a single institution experience with 17 surgically treated tumors over 19 years.J Gastrointest Surg. 2009; 13: 1071-1077
- Radio-frequency ablation for symptom control in a patient with metastatic pancreatic insulinoma.Clin Endocrinol (Oxf). 2002; 56: 557-559
- Treatment efficacy of radiofrequency ablation of 338 patients with hepatic malignant tumor and the relevant complications.World J Gastroenterol. 2005; 11: 6395-6401
- Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating.Pancreas. 2000; 20: 14-20
- Necrotizing pancreatitis after radiofrequency destruction of pancreatic tumours.Eur J Surg Oncol. 2004; 30: 85-87
- Radiofrequency ablation for locally advanced cancer of the pancreas.JOP. 2006; 7: 1-4
- Radiofrequency ablation in pancreatic cancer.HPB (Oxford). 2006; 8: 61-64
- High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer.J Surg Oncol. 2006; 94: 392-395
- High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer.J Surg Oncol. 2007; 96: 89-90
- Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas.Langenbecks Arch Surg. 2007; 392: 55-60
- Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with 'cool-tip needle': report of 18 cases [Chinese].Zhonghua Yi Xue Za Zhi. 2008; 88: 391-394
- EUS-guided radiofrequency ablation in the pancreas: results in a porcine model.Gastrointest Endosc. 1999; 50: 392-401
- Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model.Gastroenterol Res Pract. 2012; 2012: 431-451
- EUS-guided radiofrequency ablation of the porcine pancreas.Gastrointest Endosc. 2012; 76: 1039-1043
- Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis.Pancreas. 2014; 43: 938-945
- Successful arterial embolization of an insulinoma.JAMA. 1982; 248: 1353-1355
- Arterial embolization as definitive treatment for benign insulinoma of the pancreas.J Vasc Interv Radiol. 1992; 3: 639-644
- Embolization of an insulinoma of the pancreas with trisacryl gelatin microspheres as definitive treatment.Cardiovasc Intervent Radiol. 2008; 31: 659-662
- EUS-guided alcohol ablation of an insulinoma.Gastrointest Endosc. 2006; 63: 1059-1062
- Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma.Acta Gastroenterol Belg. 2008; 71: 333-337
- Treatment of insulinomas with alcoholic ablation [Danish].Ugeskr Laeger. 2012; 174: 501-502
- Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia.Eur J Gastroenterol Hepatol. 2009; 21: 1097-1101
- CT fluoroscopy-guided transcaval radiofrequency ablation of insulinoma.J Vasc Interv Radiol. 2011; 22: 409-410
- Endoscopic ultrasound guided radiofrequency ablation for pancreatic cystic neoplasms and neuroendocrine tumors.World J Gastrointest Surg. 2015; 7: 52-59
- Radiofrequency ablation of pancreatic neuroendocrine tumors; a pilot study of feasibility, efficacy, and safety.Pancreas. 2014; 43: 938-945
Article info
Publication history
Published online: September 19, 2015
Accepted:
August 7,
2015
Received:
March 10,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Lakhtakia at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.