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EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos)

Published:September 19, 2015DOI:https://doi.org/10.1016/j.gie.2015.08.085

      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)
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