Radiofrequency ablation for the management of symptomatic pancreatic insulinomas

Abstract

Background and Aims: Insulinomas are among the most common types of functional pancreatic neuroendocrine tumors and can cause debilitating, recurrent, symptomatic hypoglycemia. Pancreatic resection can be curative, but many patients are not candidates for major pancreatic surgery. EUS-guided radiofrequency ablation (EUS-RFA) is a novel minimally invasive technique for ablation of pancreatic tumors. Methods: In this article and accompanying video, we describe the EUS-RFA ablation device, provide instructions for device setup, and review outcomes of a case series of EUS-RFA for symptomatic insulinomas. We also review the current literature describing EUS-RFA for symptomatic pancreatic insulinomas. Results: This series of patients in the United States, as well as studies performed in other countries, suggests normalization of insulin levels that appears to be sustained over months to years following the procedure. There has been a favorable adverse event profile in the case series reported to date. Conclusions: EUS-RFA is emerging as a promising option for the management of symptomatic insulinomas, particularly for patients who are poor surgical candidates or who decline surgery.